by Randy Nikkel Schroeder
NEWEST PRESS
2026/$23.95/342 pp.

I’ve never read a book like Sinner’s Banquet. Randy Nikkel Schroeder has created a dark (and funny!) romp of a novel that fuses real and imagined Mennonite culture, noir tropes, Shakespearean-style insults and a deep goth sensibility.

The opening chapter drives you into the narrative at high speed with the surprise of Lethbridge, Alberta, being called “LA” and the energy of Schroeder’s similes such as “white as a peeled creamsicle.” The novel’s wild plot, which takes as many twisting turns as the protagonist’s turbocharged Cressida, involves the plight of Luke, a shunned Menno (due to adolescent sexual shenanigans in a church) now residing in Vancouver and working as a dealer, who gets on the wrong side of Serendipity Hamm, the “benzo queen,” after he tries to pull a scam. Fleeing back to his past with his doomed buddy Buddha to attend his uncle Ezra’s funeral, Luke just gets more wacko as he meets up with childhood accomplices, such as the deviously erotic Nora, and they plot revenge. I can’t give away the gory deliverance, but I must warn you, it’s intensely abject and not for the faint of gut.

The trio’s initial plan turns ever more complicated as it draws in a dastardly embalmer, a vicious gravedigger, an incipient deacon, Andy, who got the moniker Ratzy (for being a tattler), two dashing cops, a Hutterite and a nasty biker called Moby Dyck. The story recalls Raymond Chandler’s hard-boiled tales, spiced with Trainspotting-style vice, with characters plucked from the mouth of The Big Lebowski’s Walter Sobchak (“I’ll dry your socks on your mother’s cross,” “I’ll make egg rolls with your foreskin.”) Benjamin Hertwig’s Juiceboxers and Susan Perly’s Death Valley also come to mind. But Sinner’s Banquet is unique, with uncommon scenes involving the history of Nazism, Dionysian cannibalism, a mysterious drug called Rumijch and the desecration of corpses. Grim, yes, but rollicking too.

The short chapters are full of clever allusions to everything from A Tale of Two Cities to Melville, insertions of Plautdietsch lingo (that “meidung” feeling), a plethora of jokes (at times repeating their “badabum” a bit too often, as when Luke inserts his “you’re a real poet” riposte with four different characters), and even some beautiful descriptions of the prairies (“the dark slopes of the Porcupine Hills and the windswept ridges of the Whaleback”). At the end of this unravelling world, Luke remains, both altered and unchanged by his brutal experiences, the entire narrative a kind of meditation on the Thomas Wolfe saying “You can’t go home again.” Sinner’s Banquet is a terrifically startling read, and putting it down, I wonder, “How am I gonna stir my butter now?”

Catherine Owen is the author of 17 books of poetry and prose.

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by Trina Moyles
KNOPF CANADA
2026/$36.00/328 PP.

Dear reader, first I have to tell you this is a biased book review. I met Trina Moyles in a non-fiction workshop for our Master of Fine Arts degrees, where she wrote a piece that discussed the stupidity of pheasant hunting. As someone who self-identifies as a pheasant hunter, I took great affront to this insult to both my heritage and my life calling. So, to counter her making fun of my life’s passions almost a decade ago (but I hold a grudge), I will tell you all about why you shouldn’t read her latest memoir, Black Bear.

When Trina was 5, her wildlife biologist father brought home an orphaned black bear cub before sending it south to the Calgary Zoo. This sparked her lifelong fascination with bears. When young, she also revered her older brother. But as they grew up, and he went to work in the oil patch and partied, this relationship grew difficult. If you like books that soft-pedal a delicately balanced conversation about addiction and the toll it can take on family relationships and dynamics, as well as how we can perhaps better understand those going through struggles, then don’t read this. Trina says she wasn’t sure who she understood less, her brother or the bear. Her writing about these relationships is provocative, yet tuned to moments of joy, and as the book unfolds you can see how thin is the line we all walk between heartbreak and love.

Don’t read this book if you like stories that seek to bridge the urban and rural divides of life in Alberta. Trina counters her upbringing in Peace River and the facets of life in a resource-extraction-driven town with her young adult years in Edmonton. But there’s not a lot of overlap. As someone who spent his formative years trying to be funny in Drayton Valley and then significantly less funny in Edmonton, I was brought back to the way the transition to the city can be jarring for those who know a very different style of life than an urban existence. To the book’s benefit, Trina doesn’t sugarcoat rural life but instead tells it like it is, allowing the reader to gather their own information about imposed machismo, the inherent fear and expected roles that women are often placed in, and the rampant abuse of booze and drugs that exists. But with all of that, Trina also shows the reader the beauty and complexity of the boreal forest and the characters, both human and bear, that inhabit it.

Throughout the book there’s a constant sense of impending climate catastrophe, whether that’s loss of wildlife, habitat, the changing weather systems, fires, human–wildlife conflict. Trina weaves her observations and research on these subjects into the personal narrative in a way that’s accessible yet articulate. She includes scientific terms but doesn’t twist the story to push an agenda. So, if you want a book that is thought-provoking and hard to put down, then I guess this might be your thing.

Trina is well known for her previous memoir, Lookout, about her experiences working in a fire tower in northern Alberta, scanning the forest through a spotting scope while also navigating challenges in her love life. Black Bear expands on that immersive experience but in a different way. Trina forms a relationship with a mother black bear and her cubs at the lookout tower. As I read about the similarities of that relationship to the one with her brother, I thought of my own past and the connections I probably misread. Maybe I misread that initial encounter with Trina and she didn’t actually make fun of pheasant hunting (she did). But maybe I was wrong about holding a grudge and you should definitely read Black Bear.

Conor Kerr is a Métis/Ukrainian author in Edmonton. His novel Prairie Edge was shortlisted for the 2024 Giller Prize.

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by Jessica Waite
ATRIA BOOKS
2024/$29.99/320 pp.

The Widow’s Guide to Dead Bastards is a step-by-step survival guide for a waking nightmare. Jessica Waite’s husband unexpectedly dies in the Denver airport on his way back to his family in Calgary—and as if that weren’t bad enough, what happens next is truly shocking. Waite unpacks in excruciating detail the hidden life of her husband she discovers piece by painful piece in the months following his death: all manner of major and minor betrayals relating to adultery, drug use, financial deception, addiction and mental health struggles.

Waite’s memoir is not for the faint of heart. Writing a highly personal story set in a big-small town such as Calgary is a brave and sometimes unfathomable project. While giving herself space to mourn the premature death of her husband, comfort her young child and maintain relationships with her in-laws, she also unwittingly unlocks a Pandora’s box of secrets that her husband has kept from her, in the process upending everything she thought about her marriage.

When I read Karl Ove Knausgård’s epic series My Struggle, I thought he was digging himself a deep hole, naming names in Norway’s small literary community. But Knausgård’s got nothing on Waite’s delving into her traumatic discoveries while trying to maintain the reputation of her former partner for the sake of her family and his. The Widow’s Guide to Dead Bastards is a tightrope walk that Waite manages masterfully.

To the reader’s relief, the second half of the book turns the focus from terrible discovery to patient and painful reckoning. Waite finds a new community of support from therapists, various healing philosophies and a small but loyal group of people who have experienced something similar. The strength of the book is her often shocking honesty. She doesn’t shy away from the nuance and complexity of her situation. She shares tender memories and fits of rage. She revels in petty revenge against one of her husband’s mistresses. She finds herself on dating apps approaching first dates and trying to figure out how to explain her unique brand of widowhood. She makes a “fuck you, Sean Waite” playlist and plays it loudly and often.

Waite’s book is not a trauma dump, and she avoids clichés and easy answers, delivering a clear-eyed memoir that looks trauma straight in the face and finds solutions both petty and profound. She does all of this while mothering a child through the grief for the man she is learning too much about. The Widow’s Guide to Dead Bastards avoids being all about the trainwreck simply because the author pops out of the derailed car and starts fixing the track herself. This is a book about healing, complicated relationships and moving forward.

Megan Clark is a writer and librarian from Lethbridge.

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Holly: It is the late 1980s in Edmonton. I am 18 and working full time as a psychiatric aide in a large provincial psychiatric hospital outside the city with 12 buildings full of people diagnosed with mental illness. The campus has beautiful grassy fields within a boundary of tall, thick trees. After only eight hours of orientation to psychiatry, I spend most of my time “sitting constant” with people who are suicidal or have eating disorders. Every unit has its own culture: some are chaotic and unpredictable, others are slow and monotonous. People stay here for a long time—months, even years. They tell me of the various reasons they were brought here, including hearing impairment, Huntington’s disease, promiscuity, acts of violence, episodic voices of God or Satan, ideas of magic, paranoia, euphoria and deep sadness.

My job is to observe and monitor each individual as they are. It is hard to see them existing beyond the unit setting; this place is like a community. For some it’s the only form of home they’ve known. Still, I hear whispers of other places: the farm, a bus to Whitby, the community up north, the parent/partner/friend who is missed.

It is hard to see people existing beyond the hospital setting. For some this is the only form of home they’ve known.

Leif: It is 1990 and I’m 18 years old. I have a home, a school, friends, a hometown. More than that, I am part of a community. But I have lived my life under the dark shadow of mental illness. My mom requires hospitalization for severe depression; my dad’s drinking makes my home almost unlivable. Somehow I’ve managed to carry this weight while holding down jobs and buying cars, motorcycles, clothes and video games.

I have experienced severe, crushing depression for most of my teenage years. I’m under incredible stress, going to school during the day and working night shifts at a grocery store. Home life is even worse than my toxic workplace. My dad has grown angrier, more violent and less logical since I became old enough to move out, even though I’m not done high school. As this pressure cooker heats, I begin to show the classic signs of bipolar disorder with psychosis, and later, symptoms of schizophrenia with severe anxiety. One day I pick a fight in school and am non-compliant with the school administrators. When the police arrive, I fight with them too. There are no more options: I’m taken to Alberta Hospital. My hopes for the future shatter at once. I’m locked up, heavily medicated, disconnected from everything around me.

My hopes for the future shatter at once. I’m locked up, heavily medicated, disconnected from everything around me.

Holly: Five years go by, and I keep this job while finishing a nursing degree. After graduation I move to the US and start working at an inpatient psychiatry unit. Here the care is different: the people come in only for stays abbreviated by managed care. The units are locked. There are no grassy fields or recreational outings. The units are busy, with a frenzied energy that comes from having people with mania and psychosis in a small space. Restraints and seclusion are regular occurrences, often exceeding the capacity of available seclusion rooms. People come in sick, are medicated heavily and sent out to community or day-hospital programs—or the street. They come back with signs of the outside: dirt from the street embedded in their skin, new drugs in their toxicology screens, new stories of relationships and struggle.

This, however, is the 1990s, “The decade of the brain.” We are all enchanted by the promises of new medications and believe in the potential cures. Like alchemists we tinker to find the right mix of medications, monitoring side effects and symptoms. We shape our patients through chemical compliance. Side effects appear more often than we’d like—but the pharma sellers convince us otherwise, so we tell our patients to eat healthy and give the medications time to work.

Leif:The hospital works a miracle. In just two months I go from violent, raving mad, delusional and psychotic back to “normal.” Sane, stable and as capable of functioning as I ever was. I find work at a factory but am unable to keep up. I blame the medication and stop taking it. I feel fine.

The feeling doesn’t last. I begin to hear radio announcers say grandiose things about me, like I have wealth beyond measure and movie stars are romantically interested in me. I think maybe I just need the discipline and structure of a military lifestyle to keep the voices at bay, like I had in cadets. The first Persian Gulf War is flaring up, and so I try to join the Canadian Army. I’m turned away because of my psychiatric records. I sell my motorbike for $20, close my bank account and hitchhike to the west coast. I meet new people, make new friends. I’m having the time of my life. But without medication the psychosis eventually comes back, and with a vengeance. After returning home, then spending another six months living in Vancouver, going hitchhiking and trying to earn a pilot’s licence, my illness returns. Hospitalization and more medication follow. I leave what little I have and return to Edmonton with nothing.

Once again I’m homeless, only this time in my own city while on a medication that leaves me debilitated. I run into people I went to school with and tell them I’m sick and waiting to get into hospital. They don’t understand that I’m mentally ill, not physically sick. Mental illness had never been part of our education. I can’t function, can’t work, and I have no money or friends. My reality is poverty, delusions and hallucinations. I hope another hospitalization will allow me to function and take away the voices and thoughts that torment me.

I’m finally ready to accept diagnosis and treatment after losing everything in my life that mattered, including home, friends, family and all my possessions. I wrongly think that if I quit drinking and go back on medication, then old friends will beat down my door to reconnect. Instead, I face extreme isolation and loneliness. Several times I give up on the world outside my apartment. I sleep for days. I don’t go outside unless I need food. For a time, I have no phone and disconnect the intercom to my apartment. Over the coming years I will go off medications several times, go in and out of the hospital system, attempt suicide and put my parents through hell. There seems to be no end in sight.Holly: I’m working in adolescent psychiatry in a posh neighbourhood in downtown Chicago. My patients are almost all kids from what is considered to be the most violent neighbourhood in the US. Many of the young girls are diagnosed with generalized anxiety disorder, a diagnosis that means they worry too much. They also tell us they oversee getting three siblings and three cousins to school each morning, as mothers and grandmothers must cross the city by bus to get to work. I oversee teaching these kids about anxiety and medications. I teach them to reframe their “distorted” thoughts. They listen to me and sometimes smile with a wisdom I’m only beginning to recognize: They’ve been told this before. They know that in this clinical space we don’t understand what their home is like. That we can’t understand.

Two years later I move to outpatient psychiatry. I’m in grad school now, working on becoming a nurse practitioner. I work in an office building. Here the people I work with are “clients,” not “patients.” They come in voluntarily and sit in a waiting room quietly, then come to my office and sit in the comfortable chairs. They tell me how things are going, falling apart at times but in a more controlled way. There is a shift in power and control in this place. The keys I carry are different; there are no locked doors but there are disability forms and prescriptions. It’s hard to focus on the clinical pathways built by biomedicine that tell me what to prescribe first, second, then third. These paths tell me to diagnose symptoms and treat illness. The people in my office tell me of other paths and barriers.

Clients tell me about workplaces that are not accommodating of mental illness, of relatives that don’t get it, or of a lack of food or heat. I can hear the hollowness of cognitive therapy treatment and how disconnected it is from the problems my clients face. One day a client is reciting to me their symptoms of stress and alludes to the fact that they’re hungry. They tell me about their struggles to keep perishable food cold in the warm spring weather—they have no electricity. The $300/month they live on does not go a long way. A subsidy is available, but it requires navigating a bureaucratic space. We talk about strategies to cope. One day I realize that the best way to spend the allotted 50 minutes might be to go to the utility commission with a client. Coming back into the office I see a fellow trainee who asks me where I was and I tell him about the field trip. He smirks and asks, “Don’t you have any boundaries?”

This comment gives me pause—was this the right thing to do At this point I’ve been working in psychiatry for 14 years and I’m not sure all my experience and training has made me that helpful. For many, the tinkering with medications and strategies for coping aren’t enough. The biomedical model of psychiatry is placeless; it situates all the problems within the individual and ignores the contexts in which they live. This revelation takes me in a new direction that coincides with a move back to Canada, where I find a role in community mental health nursing—working in crisis teams, home support and primary care settings. Much of my work here is creative, incorporating counselling and assessment skills with material goods such as a pack of cigarettes or a sandwich to help offset a crisis. I unpack clients’ moving boxes and help fill out rent subsidy forms. But this work isn’t highlighted on the charting forms or in workload reports that account for my time, so as funding is cut, so is my ability to do this kind of work.

Biomedical psychiatry situates all the problems within the individual and ignores the contexts in which they live.

Leif: Living on my own, money is constantly an issue. I move several times until I find a place I can afford. Rent is $160 a month for a shoebox apartment. I have a sink, stove, fridge, toilet and shower. My whole life must fit into 150 square feet. Money is tighter than ever. For my Christmas gift, I ask my best friend for a can of tobacco so I can save $25 for food and coffee. My mental health is reasonably good. I’m in remission. Most would describe me as weird; I’m not wealthy enough to be eccentric. Years pass and I wonder if maybe I’m not as sick as I thought. Without full knowledge of what could happen, I lower one of my medications without my doctor’s advice, which spells disaster. After a particularly unpleasant episode (which included running around screaming that there was a bomb in my apartment building), I have a short stint in the hospital. I’m released within a few days.

A series of mental health workers come to see me, but I convince them I don’t need to be hospitalized. Then one day I agree to go by ambulance to Alberta Hospital for an assessment. I experience a tidal wave of paranoia and am involved in a chase around the grounds of the hospital. I spend the next six months confined; time slows to a crawl. I sleep all I can, as mountains of endless, frustrating time tick by. I’m unable to focus on reading or TV and have no one to talk to. I’m living the hell of constant banishment to a seclusion room, for hours or days at a time, despite already being in a confined ward. I clash with my doctor. The staff don’t believe a word I say.

When finally discharged, I feel my life is over. I have only two people on my side: a kind social worker and my formerly abusive dad. I’m placed in a well-run, supportive group home. Then, for the first time, I’m not lonely or underfed. Fifteen years pass in the group home, and I’m given a subsidized apartment in another housing project. With the support of my dad and a strong desire to tell my story and somehow make some sense of all my suffering, I publish a book about my lived experience, get a job with the Schizophrenia Society and almost by accident find work as a teacher at the same hospital that once confined me. Finally I have come out the other side. But beneath it all I’m still sick.

Flash forward to 2024. I’m now teaching two classes at Alberta Hospital and will soon be facilitating a support group too. I write for magazines and pay close attention to the news. I regularly see reference to mental illness in the media. Recently in Edmonton, a 16-year-old shot and killed two police officers, then turned the gun on his mother, then himself. I learn he was the subject of a mental health call several months earlier. In response, the provincial government promises $8-million in new funding to crisis response teams for mental health calls.

I’m left wondering why more isn’t directed to prevention efforts rather than reacting to the fallout. I wonder why wait lists to see a psychiatrist or a counsellor are preposterously long, with youth often waiting up to two years. Too often, people reach out to me for help with loved ones who have schizophrenia or bipolar disorder. I don’t have solutions, but I know that prevention programs and support for meaningful recovery should be more easily available. When I was finally placed in a supportive group home, these got me through. But thousands of people in Alberta need this help, and we have so few places like this. Parents, young and old, are often the only ones advocating on behalf of their mentally ill child.

Only when I feel fully accepted as a member of society, my mental illness fully out in the open, will I truly feel I was right in returning from Vancouver—that coming home was the right decision.

Psychiatric care perpetuates placelessness—perhaps echoes of the asylum system that didn’t require people to have a home.

Holly: I am struck but not surprised by how long it took Leif to find his way “home.” My own reflections on working in the treatment system make it easy to understand why.

What is it about psychiatric care that continues to perpetuate a sort of placelessness of the people we diagnose with mental illness Perhaps it’s the echoes of the asylum system that didn’t require people to have a home outside the institutional walls; that imprisoned people, away from the rest of the world. It seems ingrained in our practice to extract the person from their network, which limits possibilities for recovery and the “good life.” We work with some of the most structurally marginalized people. We must incorporate practices that include their sense of place.

Who we are as individuals and what we feel can both create place and be created in place. Home, then, is more than a house or apartment—it is a place of meaning and belonging, achieved by the careful arrangement of people, objects and ideas. These arrangements shift, and may be precarious, so they require constant attention and care.

Nowhere does the issue of place and belonging seem more relevant than in the current discourse around mental illness. In Canada it is estimated that at least one in five people experience a mental illness each year. Risk factors for poor prognosis and recovery include some of the social determinants for mental illness: poverty, trauma, social isolation and poor housing. Our continued focus on funding crises and acute short-term responses to mental illness does little to change the possibilities for people to find and keep a home and a place of belonging and safety. Our healthcare system needs to reconceptualize home not just as a simple address but rather as a stabilizing set of careful and meaningful social and material arrangements, a necessity for people living with mental illness.

Holly Symonds-Brown is an assistant professor of nursing at the University of Alberta.

Leif Gregersen is an Edmonton author and mental health advocate.

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Tonight we’ve gathered in an underground LRT station passageway. Beside us, a long stretch of yellow fencing separates us from a lone electrical outlet, a rare treasure in public spaces. The outlet was recently deemed too popular among the city’s unhoused citizens—hence the fence.

Through slurred speech, Brandon Shaw fawns over my toque, which reads “Hoot ’n’ Blow” beside an owl logo. I offer it as a trade for his, but he declines. Someone later explains Shaw was afraid he’d picked up lice in the shelters. He was protecting me.

Brandon is the namesake of the organization (“For B”), which was launched by his mother, Angie Staines. He’s 28 years old and still alive after 12 years unhoused—but only just. In the summer of 2022, Staines and her team found Brandon blue-lipped, deep in a fentanyl poisoning. They revived him with naloxone and oxygen. But in the ensuing months he was set on fire during a drug deal gone wrong, then suffered a kidney infection, then withered through the dysentery that hospitalized over 100 of his unhoused neighbours.

Half of Alberta’s treatment beds are in explicitly faith-based facilities, with an overwhelming focus on total abstinence.

Like everyone down here, Shaw’s life could have taken any number of trajectories. Twelve years earlier he had been a multitalented and athletic kid running full speed into behavioural challenges. “I left home for the first time out of fear and shame of the pain and harm I was causing my family,” he says. “I knew something was up with me; I just didn’t know what.” He quickly gave up on youth shelters. “I didn’t last long, because of my drug use and mental health,” he says (many shelters have strict abstinence policies). “And nobody asked me what I want or what I need.” So, managing bipolar disorder and ADHD with street drugs, the runaway teenager took up residence in a tent.

Years later Shaw would wait months on a medical detox list, only to be refused support for his potentially seizure-inducing benzodiazepine withdrawal. Given that his earlier attempts at detox from benzodiazepine-laced fentanyl “felt like having a stroke,” he was desperate for a better option.

Like so many other people 4B was out to support that night, Shaw is up against systems seemingly built to fail. Successive provincial governments have ignored survivors like him while holding fast to outdated conceptions of drug use and addiction.

In 2014 Dr. Esther Tailfeathers sounded the alarm about a sudden escalation of opioid poisonings in her native Kainai Nation (Blood Tribe or Blood Reserve), bordering Lethbridge, where she practises family medicine and advocates for harm reduction. “I had no idea we wouldn’t get on top of this, we wouldn’t have a good strategy—[that by 2024] we’d still be chasing the tail of the problem,” she says. At the time, she remembers, “We thought we were an anomaly, that it wasn’t happening anywhere else to this degree.”

Kainai was at the vanguard of the cataclysmic shift in Canada’s criminalized opioid supply, from use of regulated pharmaceuticals and “old-school heroin” to potent synthetics such as fentanyl that are made without opium poppy. Recognizing the trauma of people who use drugs, their families and frontline responders, Tailfeathers’s daughter Elle-Máijá documented the period. In 2021 she released the film Kímmapiiyipitssini: The Meaning of Empathy. 

Recently the doctor and her daughter “started counting the number of people in the film that have died. It was over half of them.”

Alberta has lately seen a seven-year drop in Indigenous life expectancy. In 2015 life expectancy for a First Nations man in Alberta was 67; today it’s 60. For First Nations women, it’s dropped from 73 to 66. This decline has been attributed in large part to our province’s narrow scope of drug policies, centred on abstinence. To Tailfeathers it seems like a conscious reframing of John A. Macdonald’s “clearing the plains” starvation politics. “Macdonald and all these other leaders thought they knew what was best for Indigenous people,” she says. “In 150 years there’s been no change… Making decisions about us, without us, is still colonial.”

During the NDP term in government (2015–2019), AHS incrementally piloted and adopted interventions falling under a “harm reduction” umbrella, such as naloxone distribution, supervised consumption sites and prescribed injectable hydromorphone. But these measures were too little, too late. While the tide of regulated opioids retreated—in an overcorrection to what some experts saw as loose prescribing practices—annual toxicity deaths in Alberta rose from around 100 in 2012 to 805 in 2018. In 2023 Alberta was on track to exceed 2,000 opioid-related deaths for the first time. (The data is not yet finalized.)

Elaine Hyshka, Canada Research Chair in Health Systems Innovation at the University of Alberta, still agonizes over the opportunities missed in the early days of the crisis. “The exponential increase in deaths was directly related to a change in the illegal drug supply. Before, people were primarily using prescription opioids. Those became less available, and the illegal market moved to fill that void.” With dangerous drugs flooding in, and deaths rising fast, drug policy experts called for immediate harm-reduction measures to save lives.

In the years since 2019, however, harm reduction has been turned into a political wedge, and “addiction,” an amorphous term increasingly avoided by drug-policy experts, has been reinforced as the nexus of public interventions. But we’re taking aim at the wrong target, says Hyshka. As Brandon Shaw’s story illustrates, this isn’t an addiction crisis, it’s a mass poisoning.

Successive provincial governments have ignored survivors like Brandon while holding fast to outdated conceptions of drug use and addiction.

When Jason Kenney’s United Conservative Party took power in 2019, it began cutting harm-reduction services. By 2023, grassroots overdose prevention sites had been criminalized, the number of supervised consumption booths in Alberta had been reduced by 35 per cent, and every patient in Alberta accessing a prescribed supply of hydromorphone (a synthetic opioid) was forced to accept a regimen of “witnessed oral dosing” in central facilities. To harm-reduction advocates, these restrictions became synonymous with the government’s recovery-oriented (or abstinence-oriented) focus.

Brandon Shaw experienced first-hand the staggering increase in poisonings during the transition to synthetic opioids. “I moved to BC [in 2013] when you could still buy actual heroin. …I had a somewhat normal life, working day labour, living in a ‘wet house’ [sober-living facility with loose rules]. Then fentanyl came along and everything changed.”

“At first, we just thought we were getting strong-ass dope… then we noticed all our friends were dying. My routine was on its head. Before, I would use four times a day. Then fentanyl came out and I was using sporadically, at weird times of day.” Shaw describes fentanyl’s lack of “legs,” its shortened effects compared to heroin or other opioids. After losing many friends to poisoning, he recognized the threat to his survival and returned to Edmonton in 2015.

As in BC, the ground in Alberta had fundamentally shifted. But a public health response equal to the crisis was nowhere in sight in this province. With few options to choose from, Shaw returned to residential treatment for his third time—for his first, as a teen, he had been involuntarily committed through the Protection of Children Abusing Drugs (PChAD) Act. He would eventually tally a total of seven attempts in the system.

Through these stays in “rehab,” Shaw learned some basic living skills. But these didn’t help him overcome his biggest barrier: securing stable housing. What he needed, according to Alberta’s drug-treatment system, was to be drug-free. “When you’re using drugs, that alone really screws you for a lot of options—there’s very little low-barrier housing. A lot of these places are 12-step-oriented.”

The 12-step method, developed in the 1930s for people dependent on alcohol, is rooted in Christian values to support people through abstinence. Countless people credit 12-step’s community support for their eventual success in maintaining abstinence. But the method has its limits and drawbacks. Critics refer to the community shaming that reveals itself, as one example, when people admit to resumption of drug use (or, to use the more stigma-laced term, when they “relapse”). Speaking of her own experience in a 12-step program, New York Times journalist Maia Szalavitz put it bluntly: “Such clearly religious practices would not be accepted as medical or psychological treatment for any other condition.”

An internal AHS document reveals that 12-step-based strategies are central in publicly funded facilities harbouring three-quarters of Alberta’s treatment beds. Around half of Alberta’s treatment beds are in explicitly faith-based facilities. Between religious undertones and an overwhelming focus on total abstinence from drugs, rehab can exclude people seeking other approaches to recovery, including ones that don’t aggravate their existing shame.

But one life-altering experience in treatment stands out for Shaw. “I’ve experienced all kinds of trauma through the last 12 years,” he says, summarizing lifetimes of harm in one breath. During an extended stint at Our House Addiction Recovery Centre in Edmonton, Shaw says, he underwent six months of trauma therapy with a professionally certified counsellor. That length of time “was the only way I was able to get vulnerable… I had to trust him more than anyone I’ve ever trusted.”

Trauma therapy, however, is expensive, intensive and outside the scope of most treatment facilities in Alberta. It takes weeks or months to conduct pre-screening and ensure that a participant is in position for routine follow-up and therapeutic work outside of regular sessions. In effect, trauma therapy requires someone to be sheltered, supported by a close network and ready to face their demons. Shaw wanted “treatment that would fit [him] individually, not just a one-shoe-fits-all, for every single person coming in.” Instead, the option offered by most rehab facilities he visited in Alberta seemed to create “a revolving door. It doesn’t work.”

After decades of advocacy by mental health professionals, Alberta not long ago was set to expand its therapeutic options. But in 2021, a day before the ribbon was to be cut on the College of Counselling Therapy of Alberta, the provincial government announced the college was “no longer a priority.” It cancelled the launch, preventing the professionalization of oversight and regulation of mental health and addiction therapy. Instead, the Kenney government doubled down on treatment facilities that are cheaper and unaccountable.

The lack of accountability at Alberta’s existing treatment services troubles Tailfeathers. “Without evaluation, we have no idea what works and what doesn’t,” she says. “[A program] might look good, but are we actually evaluating whether it’s successful or not Is there an overall decrease in mortality, an increase in people returning to the workforce, children staying in their households with their parents?” Our government is “shooting from the hip, putting all their eggs in one basket.”

Despite regularly publishing data on drug-related EMS-dispatch and drug-related mortality, the government of Alberta hasn’t shown how treatment impacts the odds of survival—if it even knows. Hyshka suggests the starting point to assess success would be to see if people who attended treatment “had any EMS activations or attended a hospital for substance use disorder for six months and one year following discharge.” In Alberta’s centralized medical system, this should be easy.

Alberta’s Ministry of Mental Health and Addiction did not reply to any of my questions. Reporting requirements to the government were, however, disclosed to me by a director and a manager at two private but publicly funded residential treatment facilities and a staff member at an AHS detox facility. (They requested anonymity to protect their provincial funding.)

The responses from the three facilities provide a rare insight into the government’s selective data management. By collecting client participation data such as number of people initiating and completing treatment, number on wait lists, and participant demographics, the government attends to the needs of the treatment industry.

Conversely, the government appears to actively ignore client outcomes, including how many people maintain abstinence or even survive in the months following their participation in a treatment program. And while the government tracks the number of people discharged early from treatment and the reasons for early discharge, this information is not publicly disclosed. As a result, the industry is protected from evaluation and scrutiny while clients continue to be ushered through the system. And the fact that one facility admitted to a “triage process” while another did not suggests the possibility of “pay-to-play”—priority access for people with the right network and a willingness to make donations.

The collecting of data on people using services and what helps them complete programs can create an impression that the programs are supporting recovery goals. But this hinges on how we define recovery and success. The lack of follow-up with patients, says Hyshka, “means the system isn’t accountable to [the public] or to patients. If you’re a politician and you’re not measuring success, you can’t be held accountable for your policy decisions.” And as Shaw points out, a “revolving door” system in which clients leave treatment only to re-enlist months later—at thousands of dollars per stay—represents a tremendous business opportunity.

It turns out that, in the distinct but overlapping worlds of addiction and drug poisoning, definitions of “recovery” and “success” are not universal.

The Alberta government claims that “acute interventions,” a veiled reference to harm-reduction services, have “come at the expense of supporting the long-term wellness and recovery of individuals, families and communities.” The implication is that helping people stay alive while using drugs comes at a cost to the individuals and their communities by delaying their transition to “recovery.” The government defines recovery as “a process of sustained action toward physical, social and spiritual healing and wellness while consistently pursuing a substance-free life.” This contrasts with harm-reduction-oriented definitions, many of which centre a person’s own goals related to drug use alongside informed consent on supports.

The goals, actions and performance metrics built into recovery-oriented (abstinence) systems of care are detailed in the 2023–26 business plan for Mental Health and Addiction. The ministry’s budget is $300-million for 2023–24, of which at least 80 per cent is allocated to addiction and mental health recovery programming and capital costs. In a rare instance, the plan specifies a secondary objective of reducing “opioid-related overdoses in the province, with a focus on Indigenous Albertans who are disproportionately affected.” The initiatives listed are limited to residential and day treatment, a helpline and an expansion of the Virtual Opioid Dependency Program (VODP)—hardly a complete recipe for managing a toxic drug supply.

The VODP was originally designed to provide access for people in rural settings to treatment and opioid agonist medications (such as methadone and Suboxone); it was recently adopted for use in prisons. However, a 2022 study funded by AHS and co-authored by Nathaniel Day, the medical director of VODP, showed considerable participant dropout. Those who could be studied, the authors admitted, “were individuals who remained in treatment and were agreeable to completing assessments, [so] they may have also had more positive outcomes.”

The best treatment for opioid use disorder is medication. “Rehab” for opioid use has little supporting evidence.

Alberta’s recovery-oriented system is operating as a flimsy raft in a storm of toxic drugs, unaffordable housing and structural neglect. Thousands of Albertans, unable to hang on, are annually lost at sea. Others, with resources, luck and a willingness to define recovery as abstinence, are eventually carried to dry land. How many Albertans are saved, and for how long, our government either doesn’t know or won’t say.

In their emphasis on mortality, advocates for harm-reduction options misinterpret the ideology underpinning Alberta government’s approach to the poisoning crisis. Long term, the government’s apparent hope is that its recovery-oriented system will give rise to drug-free communities. In the short term, however, the “pursuit of a substance-free life” is being prioritized over minimizing death and illness caused by an unregulated supply.

The way treatment programs are instructed to monitor participant mortality rates helps illustrate this ideology. An executive director at a facility (residential treatment facility #1 in the table) told me that they only learn about the deaths of recent participants through alumni, 12-step meetings, mentorship programs or when someone voluntarily reports a death to the facility. If a participant’s death is reported within two months of the person’s exit from a program, it is relayed to the Alberta government. That completes reporting.

In the run-up to the 2023 provincial election, UCP candidates frequently celebrated their system’s supposed ability to reduce deaths. But during the same period, drug toxicity deaths rose steeply, topping 195 in April 2023—Alberta’s worst month on record. The government has since pivoted to a “Recovery Capital Index” to measure the success of treatment. This approach defines recovery capital as “the combination of personal, social, community and other supports that a person can draw upon to begin and sustain their recovery from addiction,” including housing, employment and family connection among the eight factors in the framework.

An individual’s index is measured at several timepoints during treatment using the My Recovery Plan app. Created by BC-based Last Door Recovery Society, the app was licensed to the Alberta government through sole-source contracts totalling nearly $1.8-million.

David Hodgins, a professor of psychology at the University of Calgary, describes recovery capital as an “increasingly recognized construct describing dimensions of recovery beyond reduction of problematic substance use.” He points out that no research yet exists on whether the app improves outcomes, though this is typical for mental health apps. Hodgins is also careful to emphasize that recovery capital “has nothing to do with reducing drug poisoning deaths, beyond the idea that more people being successfully treated is a good thing. It may help people maintain abstinence by pointing out areas of strength and areas of need.”

The director at residential treatment facility #1, mentioned previously, was enthusiastic about Alberta’s new framework, saying, “I see the successes every day… Recovery capital is measured in simple points: when they come in, at the 30-day mark, when they exit… we see huge increases at those points and huge decreases in the barriers to recovery.”

Recovery Capital Index scores, if they improve—and assuming they can be trusted and are released transparently—may eventually help justify the Alberta government’s focus on rehab. But, says Hyshka, “if the number one goal is to reduce the death rate, funding treatment beds is not going to do that.”

She emphasizes that the gold-standard treatment for opioid use disorder is medication, while residential treatment has little supporting evidence thus far. In any case, she reminds us, “a large percentage of people who use opioids or other substances are not going to meet the criteria for substance use disorder [or for being admitted to treatment], but they’re still at risk of dying—especially if they’re accessing drugs from the illegal market.”

The Mental Health and Addiction ministry’s $300-million budget in 2023–24 is a roughly 40 per cent year-over-year increase. This is laudable spending against historical underfunding on mental health and substance use supports. But the same budget announcement designated just $14.5-million for supervised consumption sites, a 30 per cent drop that was obscured in subsequent budget releases. Underscoring this quiet manoeuvring, the UCP’s fall 2023 annual general meeting passed a resolution calling for the wholesale defunding of supervised consumption services. And the Alberta government continues to build out its plans for its notorious Compassionate Intervention Act. This legislation is expected to empower police, families and healthcare providers to obtain court orders that compel people deemed a danger to themselves or others to undergo addiction treatment.

“Tough love” might seem compassionate to some. But Hyshka says the evidence shows that people are at “much higher risk of death from poisoning” following a period of forced abstinence. She also worries that “we already have trouble encouraging people to talk openly about their [drug] use and speak out and reach for help when they need it.” Fearful of being subjected to involuntary treatment by those they trust, “people will stop reaching out for help.”

Despite plans to construct 11 “therapeutic communities,” at least four of them in First Nations communities, including Enoch Cree, Kainai, Siksika and Tsuut’ina first nations, the government is signalling further privatization in the ownership structures. Not only will the success rates of treatment remain unknown to the public and to patients, it’s unclear how public money is being spent. Tailfeathers is troubled by this lack of transparency: “It’s like building all the brick residential schools… we’ve got these things built, but nobody knows what happens inside.”

The government’s first such contracts, in Red Deer and Lethbridge, were awarded to Edgewood Health Network and Fresh Start Recovery. Edgewood is a private company backed by undisclosed investors, while Fresh Start is a non-profit. Both corporations are perennial Lead Sponsors of the Recovery Capital Conference, a public centrepiece of the UCP government’s recovery-oriented system of care.

The conference also happens to be organized by Last Door Recovery Society, the organization that licenses My Recovery Plan to the Alberta government. After a former staff member was charged with multiple sexual assaults in 2023, Last Door came under fire for alleged attempts by senior staff to prevent survivors and community members from coming forward. As individuals and treatment facilities load recovery capital scores into My Recovery Plan to shore up the government’s appearance of system monitoring, Last Door will grow its financial capital. Reducing deaths will remain a secondary concern.

To Tailfeathers, addressing deaths must be a top priority. The trauma of unending crisis and loss is “wearing down people at the frontlines,” while the government’s strategy is “way off the mark in terms of… healing people who are seeking the drugs.”

“If politicians are not measuring success, they can’t be held accountable for their policy decisions.”

It’s a sunny fall day seven months after my first meeting with Brandon Shaw, and my phone call with him is interrupted by someone dropping boxes of naloxone at his apartment. He’s been housed since spring, after detoxing at home with Staines’s support and getting access to a safe supply of hydromorphone. When he picks up the phone again he tells me, “Things are going amazing. I’m at a place in my life where I have more now than I ever have—emotional supports, people I work with in advocacy—all these people now that have come into my life…  Without my mom, I can’t guarantee you I’d be here today.”

When he was unhoused, he says, he was stripped of his voice and “tired of people crossing the street to get away.” With the support of 4B Harm Reduction, Shaw has launched a public education project—The Curbside Philosophy—to restore power to his community. As a society, he says, we spend so much time talking about unhoused people—Shaw wants us to speak with them. His project makes short videos situating real people inside the politics.

Not everyone from Shaw’s past has been able to transition to a life like his. “What keeps me up at night are the people I had to leave behind,” he says. His voice breaks as he describes the displacement of people who used to meet every day at the recently relocated Boyle Street Community Services, a ripple effect of the gentrification that is driving unhoused Edmontonians and their services out of the core.

Shaw knows his luck—in having Angie Staines as his mother, in surviving his interludes between the “revolving doors” of treatment, in finding a purpose with 4B Harm Reduction, in the grassroots community that supported him while he faced exclusion by the system. “I don’t want my whole recovery to be founded on… the fear of 12-step—having to tell everybody what a screwup you are. …When I screwed up, my community was behind me. People were just happy to see I wasn’t driven by fear and shame.”

Euan Thomson co-launched EACH+EVERY, which supports evidence-based, humane solutions to unregulated drug toxicity.

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AFTER C-19

More bad news started pouring in from Italy and France and Spain. Switzerland, one of the most affected countries, declared a nationwide emergency. This writer’s residency—in a small village in Switzerland on the gentle slopes of the Jura Mountains—was going to shut down indefinitely. I packed my suitcase, not knowing what awaited me. It was near impossible to contact the airline.
The day I packed my bags was followed by a long night when I got my first anxiety attack (of 2020). I recovered, certain I was not going to let it become as bad as it had after 9/11. I was “fine.” Fortunately, the head of the residency made a generous exception for the last two remaining writers, me and a novelist from Germany. We were allowed to continue and self-isolate in our studios—studios designed with solitude in mind.
If I stay here, I thought, I will also make way for someone who needs to return to Canada more urgently than I do. It is lockdown and quarantine more or less all over the world. Here I will be able to walk and reflect and write, I thought. I was fine with the föhn winds (all that is solid melts in the air) and the unnecessary spring. Bees, ladybugs, electric-spark houseflies and small leaves fledged. I was not able to write, but I was fine surveying the dystopian world online and witnessing the collapse of fictions most countries in the world tell about themselves, until a fortnight later a boulder-heavy band gripped around my chest—a near continuous shortness of breath, a sore throat and a nose/eye infection and insatiable thirst for water.
Contagion?
No, said the stoic village doctor, no, he said, no, when he visited me the second time. “What you are going through is extreme levels of anxiety.” The thing was exacerbated by my PTSD (connected to surviving the pogroms in India in 1984). He opened his home-healthcare shoulder bag and took out a benzodiazepine medication. He had lots of Lorazepams in his black bag. There was more than a metre’s distance between us and yet we could not look each other in the eye. What if my negative test result (the nose swab sample analyzed by the lab) was actually a “false negative?” I asked. The doctor readjusted his facemask. So did I, both worried about ourselves and each other, and I knew the first few scenes, the opening chapters of the rest of my life. Both the doctor and I, in strange solidarity, waiting, for now, for afterwardsness, if such a thing remains possible in a world gone logarithmically ambiguous. The only certainty: this catastrophe will be followed by yet another. Perhaps both of us in silent agreement that there was still room for hope in an epoch of unhope, that in the days ahead what “we” (each person on this planet) do, and what we don’t do, and what is done to us, may change our highly interconnected lives and our planet more than a world changed by a virus.

JASMINA ODOR
HARD, SHARP AND DANGEROUS

In those early March days when the epidemic became a pandemic I was home with a newborn, my first baby. He had arrived during that deadly week in January when Edmonton was locked down by unceasing temperatures in the minus forties. We took him home from the hospital in the evening darkness of that cold, on roads completely covered in hard ice—the baby bundled and tiny and squished-looking in the brand new car seat, my husband turning off the main road into our neighbourhood as soon as he could, losing his nerve with the usual traffic. Before the elation of bringing the baby into the warm house, we were tense and terrified of any inadvertent slip—not being able to stop at a light, skidding out on a turn. Once home I thought I never want to leave this house again. In the weeks that followed I paid only peripheral attention to COVID-19. When I met a friend for coffee on my first outing sans baby, and she suggested we plan a visit with both our families “before the pandemic hits,” I was surprised. Of course, she was right—within a few weeks we were all in lockdown.
The pandemic is, in fact, much like first-time parenthood. Few things make us feel as vulnerable as being the sole guardians of tiny helpless beings we want so much to thrive, and thrive in safety. You can no longer, for instance, see anything in your house not in relation to your child’s safety; there’s a quality of terror, as if the light has changed slightly to suddenly reveal innocent objects as hard and sharp and dangerous. And COVID-19 has given us an equivalent of that vulnerability on a social and global scale. The danger seems everywhere, in all the ordinary and until recently harmless things of our daily lives—our grocery cart, our mail, the friendly family passing us on the trail. Our parents and friends. As with a baby, the risk is low but the consequence potentially so terrible that we dare not relax our vigilance.
And of course we can’t anyway, because in the case of this pandemic, one person’s risk is every other person’s risk; we are not staying safe only for ourselves. And that is the other stark thing COVID-19 has highlighted for me—the way the health of one of us is related to the health of all of us, just as a baby’s well-being depends not only on its parents but also, in a foundational way, on the whole social, familial and economic net it finds itself in, something akin to water to a fish, hard to see with any perspective because it is so taken for granted. One wishes we could apply this obvious connection to all our social structures, and that when the next pandemic hits we could really be in it together—equally, not just theoretically.

SID MARTY
THE OLD GEEZER’S SHOPPING HOUR

Our friend Beth phoned and learned that our eldest son, Paul, was staying overnight in our little guest shack. “Give him a hug for me,” she said. Myrna said no. “We have to keep our distance.” “Oh,” said Beth, sadly. “Well, just poke him with a stick, then!”
For a rural freelance writer the COVID-19 crisis is otherwise a bit surreal. There are not enough hours in a day for me to keep up with the maintenance on our small holding. The season is announced by the chorus frogs and the common snipe and confirmed by a sudden charm of goldfinches as we watch the skies anxiously for late arrivals. And social distancing I’ve been doing that since about 1980. If not for my wife, I would turn into a complete hermit. But on our weekly trip into Pincher Creek, for the geezer-only shopping hour, we come face to face with masked strangers (our neighbours) and the peril suddenly gets real.
Still, COVID-19 is mainly an urban stalker; cancer and heart disease thrive everywhere. We’re in the cane and pain demographic, a lonely place of disappearing friends, two of them in the last week alone. In the grocery store lineup, white-haired neighbours eye each other over their outlaw bandanas and wonder who’s next. Like clay pigeons in a shooting arcade, we totter along our predetermined track, then it’s as if a shot rings out because—bing; one of us goes down, never to rise again.
I’m distracted from the pain in the outer world by the terrific pain my wife suffers every day in her joints. They are bone on bone. Meanwhile, Alberta is the only jurisdiction on earth where the doctors are suing the health minister in the middle of the pandemic; they say they will withdraw from the local hospital in July. We support them, but this is an awful worry. My wife is one of thousands of Albertans, some waiting over two years for so called “elective” surgery, who will now face even longer delays while hospitals operate below capacity, waiting for the next wave of COVID. She can no longer “get down and dirty” in her garden, which is the centre of her life at this time of year.
What we needed were some planters, about 31″ high, to allow for stand-up gardening. The local building supply (risky to enter these days) was down to 27 boards. This is where “Thank god I’m a country boy” kicks in. My neighbour has a small sawmill that turns out 1×6 rough stock. “I’ve got a bunch of salvaged 2×4s lying around here also,” he said. “Take ’em all if you want.” And so I found myself happily at work building two eight-foot-long planters with doubled 2×4 legs to take the weight of soil. The red squirrels and chipmunks watched me with interest; they have learned to follow behind Myrna and dig up every seed she plants. So I framed four screens made of wire mesh no cheeky little varmint can penetrate.
We hear about the record numbers of city people pouring into the garden centres. This is something we all have in common: a desire to grow food in uncertain times, to connect ourselves to a nurturing earth, despite all the pain and grief around us; a desire to make ourselves whole again as we weather these desperate days of the plague.

KATHERINE GOVIER
SCRABBLE ADDICT

My name is Katherine and I am a Scrabble addict. I’m nervous to be Zooming with you all but at least I’m here.
I grew up in a Scrabble-playing family. My father wasn’t as good as my mother, so they fought. When she proved her word with the dictionary, he claimed that the dictionary was wrong. Or that the word was not English.
When I had no friends to play with I’d get out the Scrabble board and make words. When I got a bingo I’d run into the kitchen to tell Mum, Hey look! I used all seven of my letters. She would say, Isn’t that wonderful. Then I’d go back out to the living room and select a bunch of great letters that fit onto my previous word, put them down and run into the kitchen again and say, Look, I did it again. The second time she’d appear quizzical, but she never called me on it.
When my first marriage broke up, Scrabble was a factor. My husband did not like to lose. We had our biggest fight about whether you could pluralize the word rice. I was sure you could and he said you couldn’t. I had the s and it led to a triple word score.
After the divorce my sister introduced me to a guy across the street. As a kid he had driven all over the prairies with his mother attending Scrabble tournaments. When he pulled his board out of its own little handmade quilted carry-bag, I knew I was dead. He beat me. No rematch.
The next man I married played Scrabble at first. Then he quit, claiming he never got good letters. My son was more of a chess type so he was out. It got down to where only my daughter would play with me. The games were grim and went on for hours.
But those days it was face to face. The downward spiral started when I got into playing online. On Facebook, on websites, with anyone, strangers, dozens at a time. There was never enough. No matter how many games I had going, the moment came when I’d played all my turns and had to sit there with nothing to do. This is in front of my computer, where I used to actually write books.
I swore it wasn’t affecting my life. But it was an obsession. At night I was always running up to my office. First thing in the morning too. My husband had to stand at the foot of the stairs and shout for me. I’d hear his footsteps and close the screen so he couldn’t see what I was doing.
Before COVID-19 I tried to quit. I swore I would stay away from the computer, work in the garden and read books. Then came the virus. It threw me back more than ever to the tiles. I read about Scrabblers Anonymous online. Your stories have made me see there’s more to life than keeping my ratings up. Maybe if I stick with this program I can get back to writing one day.

SHARON BUTALA
THE UNBEARABLE RETURN

What made it all so strange was that for the first month I didn’t know a single person who was sick, not even anyone who knew anyone who was sick much less had died, while on television I watched videos of hazmat-clad doctors and nurses clustered thickly around beds, working on the tube-riddled, unresponsive bodies of the dying. Starting with videos out of Wuhan, China, where I saw a man neatly attired in a black suit, stretched out on his back on the street, dead—in the night someone must have put him there—on to smuggled cell-phone video of a hospital with bodies lying so thickly on the floor there was no room to walk among them, staff in virtual hysterics and where chaos reigned, to videos of our own calmer, less-congested, if still fiercely alert hospitals with their fast-moving, face-masked, blue-gowned-and-gloved staff. Yet at the same time, when I looked out the windows of my condo, I saw the same playing fields, the two schools, the houses sitting as they always had in quiet rows, no one about other than one or two sauntering by, usually with a leashed dog. No sirens, no ambulances, almost no planes flying over, nothing. Just a silence so great it was eerie.
I couldn’t reconcile the two realities. I kept waiting for them to make sense, even while I obeyed the isolation and distancing rules and didn’t go to the grocery store more than once a week and otherwise pretty much nowhere. I listened to the radio and watched newscast after newscast on television, switching channels, trying to grasp the enormity of the crisis without succumbing to the sneaking fear that it would all end in food riots, lootings and heaps of untended bodies piled in the streets. Or equally, as time passed and the crisis continued to seem distant and unreal, restraining myself from simply saying “To hell with it,” and going to the mall or its equivalent just to break the tension. (Much could be said here about the isolation of the old.)
And yet, my surprising first reaction to the imposed self-isolation had been relief. Good, I said to myself, now I don’t have to pretend I’m normal, meaning, I can stay home without wondering if I’m missing some exciting or interesting happening, while also feeling guilty and inadequate because I truly am an introvert and, mostly, I’d rather stay home alone or with a friend or two for company and that is seen in our culture as abnormal and unhealthy. But by the end of week seven, when the talk of lifting restrictions began, and still I hadn’t personally witnessed any of it and nobody I knew had been seriously ill or died, mixed with relief that the crisis was really ending, what I felt surprised me. It was intense sadness, even a moment of near-despair, that despite everything everyone around the world had endured and seen, things would almost certainly soon go back to the way they had always been, and that now that would be unbearable.

BASHIR MOHAMED
DO YOU EVEN KNOW WHAT’S HAPPENING RIGHT NOW?

In early May during the pandemic I thought about my father’s death. I remember my sister shaking me awake on the morning of August 13, 2007. I thought it was nothing, so I went back to sleep. She shook me again but I fell asleep once more. Then she shook me harder, with more urgency, and said, “Do you even know what’s happening right now?”
I went downstairs, where the room was filled with paramedics and my dad lay on the floor. He’d had a heart attack. My other memories of that day are scattered but I still recall the shock I felt when I realized he would not be coming back.
I frequently think about that day and try to remember my dad and how he shaped my life. But so much time has passed; I have forgotten the sound of his voice.
My dad was a worker at the meatpacking plant in Brooks. Our family lived in Edmonton and he would often be gone for months. In Somalia he had been an engineer, but Canada did not recognize his program or give him a simple path to recertification. Meatpacking was one of the few places in Alberta that would accept a worker like him, so he jumped at the chance.
The work was precarious and the management was notorious for caring more about the quality and output of the meat than the actual workers. Many in my position—young refugees—understand this reality and have a personal connection to these plants. We know that nobody does this work out of choice—they do it so their children can have a shot at different options in the future.
Perhaps this is why the outbreak at the Cargill and JBS meatpacking plants hits so close to home. Because—to be frank—the outbreak lays bare the position of racialized people in Canada, people
like me.
Some numbers, early May 2020: Alberta meatpacking plant employees make up more COVID-19 cases than the provinces of Saskatchewan, Manitoba, New Brunswick, PEI and Newfoundland combined. The scale of this outbreak is no accident; it speaks directly to a failure in government, healthcare leadership and meatpacking plant management.
Despite this, one plant—as of this writing—remains open. And another is already returning their employees to the danger within the plant after just two weeks being closed. The lack of concern for these workers is disgusting; it’s clear this would never happen if most of the workforce were white.
To me COVID-19 has laid bare the inequalities in our society. That hurts. I am in the military, on notice to move anywhere in Canada during the pandemic. The waiting is stressful but I’m proud to be in a position where I can give back; it’s my duty. I wish Canadians could find their sense of duty to meatpacking plant workers. It’s shocking to see people who look like me—who work where my dad worked—treated in this country as if they are disposable.

TRINA MOYLES
THE USE OF FEAR

The bear emerges from the willows, a startle of black. I stop. Bear. There. A halo of mosquitoes swarms his molting fur. The willows bend, break under his bulky heft. I avoid his beady eyed stare. Hear his lifted snout. Snfff, snfffff, snffff.
I shouldn’t be surprised to see him. I work alone as a lookout observer at a remote fire tower in the Peace Country. Since April I’ve encountered more bears than people.
But the fear of coming within 10 metres of a 300-pound predator is so powerful that it practically yanks me out of my skin. I feel fragile. Incompetent. A twig of a woman clutching a canister of bear spray. Everything I had been worrying about—tasks undone, friends uncalled, life goals unfulfilled, dinner unmade—evaporates on the spot. I’m afraid of what’s going to happen next.
It wasn’t so different with COVID-19. In mid-March, I was supposed to travel to a book event in Switzerland. “I have a bad feeling about this, Trina,” a friend told me. He had been reading extensively about COVID-19 cases spreading into South Korea, Iran and Italy. “I don’t think you should go.” I looked at him skeptically.
A week later Italy’s hospitals were overrun with patients. Death count: rising. The country went on lockdown. I watched a video of Italians singing from their balconies. Another of people warning the world: Please, take this seriously. I cancelled my plane ticket to Switzerland.
Words like “quarantine” and “social distancing” became a regular part of my vocabulary. I obsessed over Dr. Hinshaw’s daily updates: cautionary advice, closures, cancellations. Total cases in Alberta: rising. Total global cases: skyrocketing. Even in a small northern town, where “social distancing” is already something of a norm, the streets emptied of people.
I couldn’t sleep. I’d wake at 3 a.m., my chest tight, the sheets soaked. I googled symptoms repeatedly. Total global death count: rising. Did I have COVID Was I unknowingly infecting people far more vulnerable than my 35-year-old, able-bodied self My freelance writing contracts weren’t impacted by COVID, but I struggled to make sense of my panicked thoughts. Word count: 0.
I was afraid for the well-being of my parents. For friends living in cities across Canada, in New York City and sub-Saharan Africa, where some public health officials worried COVID would tear across the continent like a wildfire. Terrified, I watched the UCP’s ruthless cuts to health, education and environmental regulation. I learned a new phrase: “Disaster capitalism.”
As the snow melted, I packed up my belongings to fly out to the fire tower. “Never been a better time to be a lookout!” my friends joked. But it wasn’t the physical isolation I craved; rather, it was the sense of normalcy I felt desperate for, the knowing that when it’s hot and dry, there’s fire—the familiar chaos in the phenomenon of wildfire.
But beyond the black spruce the indirect chaos of COVID ensues. Horrified, I watch videos of a police SUV running over protesters, a white cop kneeling on the neck of a black man until his last breath. I say his name: “George Floyd.” I am reminded of my white privilege, and that the fear felt by those living in brown and black bodies was infectious long before COVID-19.
HUFF!
The bear stares hard at me. My knees are shaking. I’m afraid because I know I’m not in control of what happens next, not entirely. But fear isn’t a useful survival tool—not without action, anyway. I remember what the experts say: Carry bear spray. Remain six feet apart. Talk to the bear in a low, calm voice. Wash your hands regularly. Back away slowly. Avoid travel outside of Canada.
The bear ambles back into the woods. I catch my breath again. COVID-19 has made me reconsider: Who and what is sacred to me How can I transform my fear into positive action?
I climb my tower and watch for smoke. I try to write again.

The post Life in Upheaval appeared first on Alberta Views.

Perreault refused to get out of the car and the situation escalated. Four minutes later Perreault was dead, shot in the head by an officer after he’d shot one of the constables in the leg.

An autopsy revealed Perreault had therapeutic levels of two prescription benzodiazepine medications, clonazepam and lorazepam, in his blood. It also revealed “moderately high” levels of oxycodone, along with methamphetamine and its metabolite, amphetamine. 

In 2017 a fatality inquiry into Perreault’s death called for his medical records and pharmacy printouts for prescriptions for the years preceding his death. It showed Perreault had been addicted to opiate pain medication for roughly a decade after a long history of pain complaints. More than one physician in the 18 months preceding his death had refused to see Perreault or refill his prescriptions, accusing him of what’s known as “double doctoring” (seeing more than one physician so as to get more medications than a single doctor would prescribe) or breaching terms of an opioid treatment agreement (given positive urine screens for cocaine and oxycodone).

But at least one physician continued to see Perreault. In the two months prior to Perreault’s death, Vincenzo Visconti, a family physician at Brentwood Medical Clinic in Sherwood Park, saw the man on 10 separate occasions, seven of them billed to Alberta Health Services (AHS) as home visits. Visconti refilled prescriptions for benzodiazepines, a muscle relaxant and an opiate, “oxyneo.” He wrote Perreault a prescription for 14 tablets of 80 mg oxyneo, or the equivalent thereof, every seven days in the weeks preceding his death. A forensics expert testified that the combined effect of the prescription drugs with the methamphetamine ingested by Perreault enhanced their toxicity.

When Visconti’s name came up at the fatality inquiry, he was already known to the College of Physicians and Surgeons of Alberta (CPSA). They’d first been alerted to him in 2004 after an Alberta Health and Wellness report of suspected billing infractions.

In an ideal world, the way we pay doctors would align perfectly with the healthcare needs of the population. Doctors would be reimbursed fairly for caring for patients in a way that’s compassionate and personalized, skillful and beneficial, and timely yet unhurried. They’d be rewarded for services that prevent illness as well as those that treat it.

That isn’t always the case. Woven into our current system of payment for physicians is a financial incentive structure that encourages them to see more patients, to attain more specialization and to treat illness (including by prescribing drugs) rather than prevent it. This system—wherein doctors bill the government for services—often runs counter to the provision of high-quality primary care, which is considered the foundation of a strong public health system.

Fee-for-service compensation has been part of Canadian healthcare since the system’s inception in 1966. It allows doctors to practise medicine with professional autonomy. They’re not employees of the government; they use their clinical judgment in delivering patient care and are paid for each specific service. Among the benefits of a fee-for-service system are that it encourages doctors to see many patients (valuable in a health system with wait lists); it rewards industriousness; it’s familiar to doctors across the country; and it can be used across specialties. The premise is simple: A physician does X and therefore receives Y. Do more of X, receive more of Y.

Generally speaking, the fee-for-service system, the predominant form of compensation for physicians throughout Canada—and especially in Alberta—gives higher monetary rewards to doctors who see a higher volume of patients. It does not, for example, amply reward physicians who take extra time to counsel patients with chronic pain.
What happened in Visconti’s practice is extremely rare. (He declined an interview and has not spoken publicly.) But his story illustrates the worst harms that can come from a system rife with financial incentives for physicians to provide high-volume care.

On August 25, 2004, Alberta Health alerted the CPSA to concerns about Visconti’s practice. These were about billing, recording and his failure to make timely referrals. The College carried out an investigation over the next two and a half years that showed Visconti sometimes had very high patient volumes, including two periods in 2004 when he saw more than 100 patients a day over several consecutive days.

It took another five years for the investigation to be resolved. Visconti and the College went back and forth in a case that ended up several times at the Alberta Court of Appeal when Visconti disputed the charges. He said his inappropriate billings were made in error. However, in February 2012, following a decision by the Court of Appeal, the College found Visconti guilty, among other things, of submitting inappropriate billing claims to the Alberta Health Care Insurance Plan on more than 400 occasions.

The College Council discussed at length the appropriate penalty. There were no criminal charges but they felt that the number of proven allegations related to billing for services not rendered showed misuse of public funds, impugned the reputation of the profession and was unbecoming conduct for a physician. “These are serious offences… Given our trusted relationship with our patients and the public, it is extremely important that a physician be scrupulous in their billing practices.”

In the end, Visconti was required to pay for and submit to a peer review at six, 12 and 24 months after the order of council. He was suspended for 30 days and went back to his clinic.

 Fiona Clement is a health economist at the University of Calgary who studies evidence in decision-making and health policy. She says one of the inherent problems with fee-for-service is the financial incentive for physicians to perform services with the greatest rewards, and do so at high volumes. “The majority of physicians don’t think like that,” she cautions. “I think most doctors go into their office to take care of patients to the best of their ability. But underlying that is this financial incentive structure, and we do know that most humans are motivated by money, among other factors.”

Her concern is shared. In 2007 Pincher Creek family physician Tobias Gelber joined the faculty of AIM Alberta—which stands for the rather wonkish Access Improvement Measures. It’s a roll-up-your-sleeves, put-on-your-thinking-caps course of practical tips that get at the basics of healthcare: how to reduce the time patients spend waiting to see a doctor, how to improve communication when patients move between their family docs and specialists, how to organize a day of appointments so a physician has time to sit and talk and listen to patients.

To Dr. Gelber’s mind, these things are key to high-quality healthcare. They reduce expensive hospital visits, thereby cutting down on the number of people waiting in the emergency room, and improve outcomes for patients with complex chronic diseases. Studies from around the world have shown that when primary care is strengthened, life expectancy increases, mortality falls and hospitalization rates go down.

Over the next decade, Dr. Gelber met regularly with physicians, nurses and clinic staff across the province, sharing ideas and teaching AIM courses. But there was a catch that bothered him. The things he was advising doctors to do were “diametrically opposed” to the way doctors are paid. A doctor’s office that followed the goals of Alberta AIM might be offering higher-quality care to patients but potentially at an income loss for the physician.

Dr. Gelber believes this is wrong. Under the current model for physician compensation, “physicians [are] on a treadmill,” he says. “And the more patients they push through, the more money they make, with absolutely no regard whatsoever for quality of care.”

“There are literally clinics in this province where a thousand patients a day are seen,” says Dr. Gelber. “In a 10-physician clinic, each physician is pushing through 100 patients during business hours and generating massive amounts of money… That’s an extreme example, but there is a significant incentive to put through volume at the expense of patient care.”

Numerous physicians interviewed for this story gave examples of fee-for-service being “gamed”—used to the financial benefit of doctors but without clear benefit to patients. This can be what’s called “cream-skimming”—selecting patients with minor conditions who can be treated more quickly instead of caring for patients with more complex needs. It can be breaking down the steps of procedures into smaller services to bill for multiple codes. It can be overbilling by performing full physical exams on patients who do not require full physical exams, or billing for procedures that aren’t recorded in a patient’s chart. It can be refusing to perform certain low-reimbursing tasks. It can be performing excessive diagnostic tests on patients who don’t need them—actions that aren’t illegal but are not best practice.

Fee-for-service may have worked well in primary care 40 years ago when patients had fewer chronic diseases, but health needs have changed. More Albertans today live for decades with diseases requiring long-term management; 44 per cent of Canadians over the age of 20 now have at least one chronic condition. Physicians ought to discuss with patients a growing list of preventive services such as cancer screening and vaccinations. They’re encouraged to talk to patients about mental health and the social determinants of health, but issues such as housing, poverty and food security don’t fit into a 10-minute window. The entire nature of the doctor–patient relationship has changed. We’ve shifted from the scenario where physicians told patients what to do to one in which patients want more interaction with their doctor.

Fee-for-service rewards higher patient volumes. It does not reward physicians who take extra time to counsel patients

That kind of primary care cannot be easily accomplished under fee-for-service, says James Dickinson, a family physician at the University of Calgary. In its place, many physicians focus only on a person’s most acute problem—for which they can bill—and not a person’s health over time. “There are doctors in this town who have ‘One problem per visit’ posted on the wall,” says Dr. Dickinson. “When you see that, you know it’s one sign they might be a bad doctor, a doctor who is focused on money, not on care. If they’ve got that on the wall, you should be very cautious.”

Doctor bills the Health Care Insurance Plan for a patient visit based on the Schedule of Medical Benefits list. This is a publicly available, 770-page schedule of fees that has been hammered out in negotiations between the Alberta Medical Association (AMA) and Alberta Health.

Within the house of medicine, there’s tremendous rancour over the Schedule of Medical Benefits. Many primary care physicians complain they are compensated at a much lower rate than specialists, an inequity that harms primary care delivery. Specialists counter that they undergo more years of postgraduate training and many of the things they do for patients are complex—ergo, their compensation should be higher.

This issue is not specific to Alberta, but the pay gap frustrates many physicians. “People say, well, they’re specialists, they deserve more. There’s no good evidence in the world that that’s true,” says David Moores, a professor of family medicine at the University of Alberta. “The most effective healthcare system, the most cost-effective and better outcome healthcare systems, are those that are based on strong primary care.”

In the early 2000s Dr. Moores led a study that looked at the quality of care in primary care clinics across the province. Today, 15 years after the study finished, Dr. Moores still recalls a scenario described by one of the physicians in the study. A primary care doctor felt that a young man needed an urgent MRI; he didn’t want to send him to a hospital’s emergency department, where he might continue to wait. That afternoon, the physician made call after call to get a same-day MRI for the patient. No reimbursement for this kind of effort is built into the fee-for-service system. In the three and a half hours the physician spent on the phone, patients waited in his clinic, wanting care for minor ailments he could have billed for. By the time the doctor got help for the man, he’d lost hundreds of dollars in potential income.

Dr. Miriam Berchuk offers another telling example. As an anesthesiologist and a specialist in obesity medicine in Calgary, Dr. Berchuk has worked for the last several years with a primary care doctor to provide group counselling in weight management for people waiting for joint replacement surgery. Their goal is to counsel people on lifestyle changes such as weight loss that could improve their outcomes after surgery—and ultimately save healthcare system resources, adds Berchuk. She was astonished, however, by the difference in fees for her work in hospital as an anesthesiologist compared to a family doctor’s. A family doctor—who pays for staff, office space and equipment in her practice—can bill $15.85 per patient for a group counselling session slated to last two hours and attended by 8–12 patients. An anesthesiologist with no overhead can bill $30.35 for initiating an IV line when she’s called to help nurses. It takes Berchuk five minutes to do this, maybe 10 in a difficult case. This simple, fast service is, according to the fees, far more valuable than counselling a patient on lifestyle changes. “[But] how do you quantify the counselling aspects, the sitting and listening to people?” asks Dr. Berchuk. “What is that worth?”

She adds that the inequity between different specialties under fee-for-service disproportionately penalizes female physicians. Women tend to go into family medicine at a higher rate than men, and currently account for 45.5 per cent of all family physicians in Canada. Studies show that female primary care physicians engage in more patient-centred communication and have longer visits than their male colleagues. These practices can reduce income in a fee-for-service system.

Income inequity also deters medical students from pursuing primary care in favour of specialties where their earning potential is greater. Every March the Canadian Residency Matching Service matches graduating medical students to residency training spots across the country. And every year the most sought-after residencies are found in highly specialized, high-paid fields with more agreeable work hours—radiology, dermatology and plastic surgery among the top. Family medicine struggles to attract enough students. This year, 209 residency spots across Canada went unfilled, meaning there weren’t enough students interested in pursuing that kind of practice. Of these, 138 were in family medicine, including 11 spots in family medicine at the U of C. “We have 52 vacancies for family physicians in northern Alberta,” Dr. Moores says.

The AMA is trying to find a way to address these problems. In 2016 the association established an initiative to reduce income disparities among physicians. The process has been thwarted repeatedly, however, by disagreements among different specialties. In 2018 ophthalmologists and dermatologists even hired a law firm to challenge the AMA’s authority to proceed with the income equity initiative. The effort remains stalled. “Nobody wants to give up income. So if it’s a question of redistributing, it gets tricky,” says Dr. Berchuk.

The NDP government brought in a new compensation model for primary care, blended capitation, and set up a pilot program for family clinics across the province. Blended capitation allows doctors to bill fees for some services but also provides them with fixed funding to care for a roster of patients over a set time. In the end, few clinics signed up. Every physician in a practice had to join the new pay model if a clinic signed up, while the clinic was required to have a minimum of three physicians operating out of a single location. Pincher Creek’s Dr. Gelber was interested in joining but his practice wasn’t eligible. “[The government] has thrown up some barriers, which have been difficult to overcome for many physicians,” he says.

Alberta has the highest number of physicians in the country paid by fee-for-service. As of 2017 only 17 per cent of doctors here received some payment by an alternative method (such as salaries or hourly rates), compared to 68 per cent across the rest of Canada. This province’s physicians are also the highest paid in Canada. The average gross clinical payment per physician, according to the Canadian Institute for Health Information, was highest in Alberta at $386,000. Lowest was Newfoundland at $274,000.

Health economist Amity Quinn, who studies how physician payments affect patient care, says there’s no clear answer about the relationship between physician reimbursement and the quality of patient care, thus no easy solution. Studies have shown mixed results for patients when physicians are paid in bundled payments rather than fee-for-service, and other studies show that payment models that encourage team-based approaches to care did not change how physicians delivered face-to-face patient care.

One thing is certain: Getting rid of fee-for-service entirely isn’t a solution. Quinn believes the best option is a combination of compensation models across the province—some fee-for-service, some alternative pay models, but with more transparency and more discussion about health system value. “We definitely need to be clearer on our goals, and align payments models with what those goals are.”

The existing system is getting more scrutiny. As part of a 2016 amending agreement between the province and the AMA, the latter set up a peer-review system to monitor physician billings. It’s designed to be physician-led, non-punitive and focused on education. The goal is not to audit physicians—on that, the AMA is very clear. Rather, it’s supposed to educate physicians in order to cut down on inappropriate billing. The AMA says Alberta’s physicians have slowed health expenditures in the province since 2016, claiming physician stewardship has led to a savings of $544-million.

The AMA’s regular publicly available reports on billings reveal how inappropriate billings quickly add up to hundreds of thousands of dollars. One ICU physician, who mistakenly charged for multiple encounters with the same patient over a day during a hospital stay, billed nearly $200,000 in surcharge payments over a year.

The AMA isn’t the only overseer of physician reimbursement. Alberta Health regularly conducts compliance reviews and audits to detect errors, overbilling or fraud. The reviews can be prompted by complaints from Albertans and by risk assessments and data analytics. And when criminal activity is suspected, a Special Investigations Unit (SIU) of Service Alberta is called in. Since 2012 the SIU has investigated an average of 25 health files per year. In the last five years, criminal charges filed as a result of SIU investigations include one physician charged with several counts of fraud, two people charged with personation or uttering (i.e., using or passing along) a forged document and seven cases in which the SIU assisted police agencies in regards to Controlled Drugs and Substances Act.

Online reviews of Vincenzo Visconti’s practice over the years don’t paint a picture of a bad doctor. Many of his former patients say the opposite. But after the inquiry into the death of Michael Perreault, the College of Physicians and Surgeons saw otherwise. In October 2017 a senior medical adviser from the CPSA reported that the latest review of Dr. Visconti’s practice revealed concerns with his opioid prescribing. The amounts were drastically higher than other physicians’ and showed an upward trend over time instead of decreasing as recommended by chronic-pain guidelines.

In Alberta only 17 per cent of doctors receive some payment by an alternative method (such as salaries) compared to
68 per cent across Canada.

In a statement, the college noted that Visconti’s clinic’s roster of 3,500 patients was unusually large. Studies of primary care suggest a well-resourced physician practising with a support staff can safely and appropriately manage a patient roster of somewhere between 1,200 and 1,600. Visconti had directed at least some of his patients to only use a specific pharmacy in downtown Edmonton to fill prescriptions—for reasons unknown, but a practice not permitted. And, again, the College found irregularities in Visconti’s billing practices.

In April of 2018 the College gave Visconti two weeks’ notice that his licence would be suspended indefinitely. He was asked to spend the next two weeks helping patients transition to other physicians. Two dozen of his patients twice staged a rally on the steps of the Alberta legislature calling for his reinstatement.

One week after the College gave Visconti two weeks to end his practice, it announced his licence was suspended immediately. He’d been restricted to seeing patients five hours a day, banned from initiating any new treatments and had his prescribing privileges limited. But the College said he had failed to abide by the conditions.

On April 27, 2018—14 years after the first concerns about his practice were reported—the College took the rare step of suspending Visconti’s licence indefinitely under s. 65 of the Health Professions Act. Rather than proceed to a disciplinary hearing, Visconti agreed to a formal resolution of the complaints in December 2018. He is currently facing two criminal charges for allegedly defrauding the government of Alberta of more than $5,000 by deceit, falsehood or other fraudulent means.

Christina Frangou reports on health, medicine and social issues. Send story feedback to letters@albertaviews.ca.

The post The Consequences of How We Pay Doctors appeared first on Alberta Views.

That might not be true.

Where I am now is a territory of two directions: arrivals and departures. professionals move down either the left side of the corridor or the right, either toward the gates for departure or toward the carousel to collect baggage. Vendors divide this stretch, framed on the perimeter by multicoloured leather seats. It’s all huge windows looking out on pavement and the little helmeted, ear-muffled people in automobiles designed only for the airport. Folks murmur by, their voices rising to the ceiling. The ceiling calls back down, warns against unattended baggage.

I avoid the terminal’s left and right side; just peck my way through the middle, the vendors’ territory. A young man wearing a short-sleeved shirt and a tie holds a clipboard and swivels his head back and forth between the left and right streams. he makes eye contact with a woman in a pinstripe pantsuit and moves toward her.

She drops her gaze to the floor and quickens her pace.

“Miss, do you have one minute?” She keeps walking.

He spots me.

“Sir! hello, sir.” he steps my way. “Sir, you can save thousands of dollars in travel expenses every year. But it’s more than that. By switching to a prime Assets credit card, you open up a world of benefits and rewards beyond travel, including appliances, accommodations and discounts at premier car rental agencies and hotels.”

I look down at my naked wrist and pretend an imaginary watch tells me I’m running late. I know where this is going and this time it’s not my fault. That may not be true.

“I’m sorry. I really don’t have time for this.”

“Sir, it will just take one minute and it could save you thousands of dollars every year.”

“Do you just have a pamphlet or something?” A plea, not a question.

Rote overtakes the young man. he unleashes practised facial features— head nodding in cadence, eyebrows rising with every perk he mentions. But the mouth is the same, just opening and closing lips, teeth carving air into meaning. his eyes notice the difference between the professionals moving up and down the terminal and me: a suit but no tie, a carry-on but no briefcase, The Atlantic Monthly but no Report on Business.

“Just by signing up you collect 10,000 bonus reward points, and then you earn additional bonus points with every dollar you spend with the card. You could immediately cash that in for a cappuccino machine, a free car rental or even put it toward an airline seat.

Let’s apply right now, shall we?” He doesn’t wait for an answer. “What’s your name, sir?”

Hesitation.

“George Wriggly,” I say. “W-R-I-G-G- L-Y.”

“OK, Mr. Wriggly, and your address.” He writes but doesn’t look at me.

“132 Hawkbrook crescent, Detroit, Michigan. Zip code four-eight-two-oh- one.”

“Detroit A ways from home. Telephone number?”

“Uh, area code three-one-three. Five- four-seven. Oh-three-four-eight.”

“marital status?”

“I’m a widower.”

“I’m sorry to hear that, sir.” He looks up from the clipboard. The facial expressions enter different territory briefly. Arched eyebrows and squinted eyes. “do you live alone, though?”

“I have pets.” Flinch. “Iguanas.”

He laughs, but it’s back to rote, eyes down.

“OK, and what was your income last year before tax?”

“Maybe a hundred and thirty thousand.”

“Wow. And your employer’s address?”

“I work from home.”

“And what do you do, Mr. Wriggly?”

“That’s a question?”

“That’s a question.” The young man tilts the clipboard toward me and points to the question on the application form.

“I make my own soda pop and sell it to local businesses.”

“That’s pretty cool.” More new facial expressions. Half a lip in a downward curl. “What’s your soda called?”

“I call it ‘Pop’s Soda’.” Stomach dropping. “I’m Pop.”

“You make any special flavours?”

“Our specialty is coconut, but I’m in town right now doing research on a lemongrass.”

“Well good luck with that, Mr. Wriggly.” That seemed genuine, but the next part isn’t. “Now if I could just see two pieces of Id, we’ll get this processed today and you should receive your card in the next three to five Weeks.”

“That’s going to be a problem.”

“Shouldn’t be, sir, everyone needs ID to get on the plane.”

“Yeah, I have ID, but I’m not actually an iguana-owning widowed independent lemongrass-flavoured soda maker from Detroit. Everything I just told you was a lie. I’m very sorry.”

A new frontier of facial expressions. Furrowed brows and open mouths.

“Are you serious?”

I pick up my carry-on, walk past the young man and head down the terminal.

“What the hell, George?” he calls after me, scrunching my application into a ball of paper.

“My name isn’t George,” I call back. “I’m very sorry.”

This is a bad start to the trip, the whole idea of the trip. I’m not contributing to mental health.

I walk to the end of the terminal where it bursts into a dozen smaller stations, each complete with rows of conjoined polyester chairs. Stopping in front of gate d42’s row of chairs, I drop my carry-on and look back to see if the young man followed me. He didn’t, so I find my cell and call Terry.

“Good afternoon; Dr. Riesman’s office.”

“Hey, Dawn, it’s Charles Hawkins. I need to talk to Terry.”

“I’m sorry, Dr. Hawkins, Dr. Riesman is with a patient right now. can I take a message?”

“Dawn, I’m sitting in the emergency room right now covered in blood because a manic-depressive patient of mine, who happens to teach the fifth grade, slit her wrists in front of her students an hour and half ago.”

“Oh my God.”

“I know, eh We’ve stabilized her, but it’s touch and go here, Dawn. So please, tell him it’s urgent.”

“Yes, Dr. Hawkins. I’m so sorry.”

I’m put on hold. A soft instrumental version of Billy Joel’s “You may Be Right” starts to play. Preboarding begins on flight AC850. The music stops when Terry picks up.

“Charlie Jesus, what happened?”

“Hey, Terry. Listen, don’t worry, I’m at the airport. I’m going through with it.”

“You have my secretary in hysterics over here.”

“I’m on AC850, so if that gets hijacked or something you’ll know I’m dead.”

“You couldn’t have just said ‘medical emergency’ and left it at that Dawn has a daughter in the fifth grade.”

“I referred my patients to you. You’re welcome, by the way.”

“Where the hell did this come from, Charlie?”

“We spent three hours talking about this last weekend.”

“Well I just assumed—” He stops. “Get out of there. Get a taxi. come here. We can work through it. Africa won’t solve this.”

Preboarding is finished and general boarding begins.

“What happened with the lawyer?” He asks.

“Didn’t work out.”

“You can’t just go to Africa, Charlie, they don’t allow it. You need shots. It’s
a war zone over there. There’s a travel advisory, charlie. Hacked to death with machetes, Charlie. You’ll get AIDS off a toilet seat, Charlie.”

“AIDS off a toilet seat How did they ever let you into med school?”

“You know what I mean. It’ll be malaria or the Spanish flu or something. This is fucking clown shoes.”

“If I stay here, nothing gets fixed.”

“The lawyers will find you there. This is malpractice; these things don’t disappear,” says Terry. “I’m not lying for you. If they come knocking, I can’t lie.”

It’s actually very easy.

“You’re fired. I’m firing you. You short little bastard.”

“You leave and you’re done. You leave, we can’t fix this.”

“I’m about to take off, Terry. I have a layover in London, I’ll call from there. Tell Dawn I’m sorry about the fifth grader thing.”

“Don’t hang up!”

I hang up.

I hope I have a window seat.

Three days before, in the office of the firm Anderson, fuller & Kaufman, I found the undiscovered country of Somaliland and claimed it for myself. This lawyer, Payton, was Terry’s idea. he’d heard good things about him, a specialist in these cases. he had the kind of office I always wanted, with a big fish tank in the waiting room, the mature-but-attractive secretary, the built-in speakers.

Payton had better magazines, too. not just Sports Illustrated, but The New Yorker. I thought to myself, I should charge my patients more. Then I could have fish, too. maybe if I charge each of my three remaining patients $12,000 a session…

That’s a lie. I have more than three patients. There are at least six.

Payton’s magazines had crisp, untouched covers with articles about important things, like poverty, disease and war in perpetuity. The one that caught my eye—“Somaliland’s Untreated: The mentally Ill and civil War’s Silent casualties.” That was the headline.

1991’s civil war…

I’m being sued, and that’s the truth. I’ll probably lose. There’s this woman I’d been treating named
Anita Exelby—an ocd case with a heightened rape anxiety and an apparent late-developing phobia of honesty—and she feels I’ve failed to fulfill my oath as a caregiver. As the attorney Mr. Payton will illuminate in the moments to come, one of the broad categories of malpractice implies physician culpability if said physician fails to anticipate a problem when his training suggests he should have. So, since I’ve studied medicine for nine years, I was supposed to foresee that our unprotected sex would lead to her sudden pregnancy. Whatever.

That’s a lie.

Actually, Mrs. Exelby and I have never had sex. And she’s not pregnant, as far as I know. She’s mad (and probably a little nervous) because she suffers from a minor anxiety disorder which is likely treatable through a course of benzodiazepines, more exercise and minor cognitive behavioural therapy. If she didn’t have the money, it wouldn’t be treated at all. Instead of telling her any of that, I told her she was inexplicably attached to the air she was breathing and suffered from acute separation anxiety every time she exhaled. my treatment plan involved limiting the amount of breathing she would do in a day and exhaling into Ziploc bags so she could catalogue and archive all the air she breathed.

Her lawyer doesn’t think I should be a psychiatrist anymore.

Neither does mine.

My mother always wanted me to be a doctor. All this time practising medicine. Just practising.

…tens of thousands killed during the four-year war…

“I hope to understand all the facts here, Dr. Hawkins,” said Mr. Payton from behind an unnecessarily large desk. Payton was a short man in a nice suit with precise sideburns. Psychiatry hasn’t been kind to short men.

“Am I to understand that you put the treatment plan—the one involving the Ziploc bags—into writing?” Payton said to me, little hands folded together.

“It’s in my notes.”

“And you record your sessions?” he said, while scratching notes on a pad.

“No,” I said.

“Dr. Hawkins, your office sent me a tape of the session in question.”

“I was just joking when I said ‘no’.”

“I see.” he stopped a moment, wrote more notes.

“I thought there was doctor/patient privilege or something They can’t use my notes in court, right?”

“No, that privacy privilege is only extended to lawyers and their clients, and sometimes police informants. These notes and recordings would be admissible.” he finished writing his notes in silence.

I wish I had my own note pad.

“Mr. Payton, am I going to get out of this one?”

“We’ll do our very best, Dr. Hawkins.”

“But if you were to handicap it, can I still be a doctor?”

“It’s difficult to be optimistic in the face of this much evidence. We will do our best. With a settlement, and perhaps relocation, the matter should evaporate. It is serious, although you might not think it.”

“Relocation So I could go practise somewhere else Like a different continent even?”

“Every jurisdiction has its own requirements, Dr. Hawkins. There is much to do before raising those questions,” Payton said. Then he went back to writing in silence.

“I don’t want you to feel too much pressure, Mr. Payton,” I said. “I can get by if I lose my licence.” I craned my neck to try to see what Payton was writing down. “Maybe I can come work with you. I have a law degree.”

He stopped writing, placed the pen down on the desk and looked up at me.

“Dr. Hawkins, may I ask you a personal question?”

“Shoot.”

“Do you have a problem with lying?” I looked up at his degrees hanging on the wall behind his desk. Three of them. That’s one more than I have. I thought of how high they hung, how he must have used a ladder. And not just a stepladder, something much more severe. I stood up.

“You’ve obviously taken sides here. You’re fired. I’m firing you. You short little bastard. I hate your office.”

I turned and left and then thought better of it and stopped halfway through the door.

“Am I still getting billed for this?” “Assuredly.”

“I’m really sorry about everything.” “Leave.”

The inhumanity of the war has claimed countless unseen victims, those devastated psychologically… Shanty mental hospitals… Helpless families… “The majority of these patients have never been attended to by a psychiatrist,” said an advocate…

These people are desperate. They’ll take anyone’s help. mine, even. I need to find a map.

Mythomania is a sickness and every admitted lie is an act of healing. I really believe that. That’s not true, no I don’t.

Psychiatrists say it isn’t clinical because we mythomaniacs know we’re lying, therefore the lying is
only a symptom of some greater psychological malady. I cleared out of my office today, locked up my apartment and am on a plane to Africa because of mythomania, which they tell me doesn’t exist.

My parents haven’t believed a word I’ve said since I was seven years old. Okay, more like 14. Actually, I shouldn’t say parents; my mother died of cancer when I was 12. Oh god, what a terrible lie to tell. I feel like I should call my mother now. I don’t know why I would say something like that.

But no, my parents don’t trust me. I told them I’m moving to Africa to make my life right and find the one person who needed the most help and fix them, and I told them that this process of healing and self-discovery would take many months of harrowing concentration, likely with long bouts of solitude and deep reflection, and that I may find myself in remote locations where communication with the outside world would be impossible, so I may go many months between talking to them, and that they should prepare themselves for terrible conclusions, conclusions that might point to them as being the source of my disability, and as such I may have to remove their presence completely from my life, so if I never see them again, while it would be difficult for all of us, they must know in their hearts that, although I would have to abandon them, I would love them always and our separation would be for the best.

“Right,” Dad said. “We’ll see you Sunday night for dinner.”

No one in my profession believes in mythomania. Well, a couple of them do, but the rest of us think they’re quacks and at conferences all of us competent, popular psychiatrists go out drinking after sessions and we don’t invite the others and we ridicule them something awful.

No, that’s a lie; I’ve never been invited out to the after-session drinking. What I previously stated was a lie I concocted in an attempt to paint a picture of myself as being more popular and competent than I truly believe myself to be. That’s the hypothesis that served as the bedrock of my peer-reviewed study. At seven separate conferences I’ve given lectures on the validity of mythomania.

That’s not true either. I’ve never lectured at a conference or had anything peer-reviewed. But pathological lying is not a recognized clinical disorder. Let me repeat that because it’s true: pathological lying is not a recognized clinical disorder. I said it twice, so it must be true. The last sentence was a lie. I don’t actually believe that my saying something twice means it’s true.

The longest relationship I’ve had in the last 15 years was the three months I dated Amanda Ziegler in my freshman year. People call me “Doctor,” I make a lot of money, wear a suit every day and can write prescriptions for anything—but three months is it. I have sex, though, mostly with my 22-year- old secretary. We have a variety of positions.

That’s a lie, we only have two positions.

That’s a lie, I don’t have a secretary.

That’s a lie, I do have a secretary but he’s 47.

Also a lie. I’ll stop now.

They’re desperate. They’ll take anyone’s help. Mine, even.

Last weekend I told Terry I was going to Africa to make up for everything: the lawsuit, my parents and—although at the time I said it I didn’t know I would owe him too—credit card guy. When I had said it, it was a lie. But here I am, on a nine-hour flight to Heathrow, sitting next to a woman who believes I’m on my way to Brussels to meet my biological father for the first time. So it’s not a lie anymore. The Brussels thing is, but I mean Africa. I’ve made it come true. Lies are just words, but I’m doing it. It’s not a lie if I’m doing it.

Andrew Barbero is a law student at the U of C. He lives in Calgary, speaks nine languages and can bench press 1,400 kg.

____________________________________________

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The post Just Words appeared first on Alberta Views.

“I know you love me,” Oler recalls saying, “but I’ve been getting the best medical care and the most powerful drugs all these years, and you think a nutritional supplement is going to fix me?” She rejected the idea. Three years later, at a wedding reception, Oler came across a pamphlet for the same nutritional supplement. A company representative (also a wedding guest) claimed that seriously ill people got well from using the supplement. Oler was spending over $600 a month on prescription medications at the time. Her daughter offered to pay for the first two bottles of the nutritional supplement, and because she felt she had nothing to lose, Oler tried it. 

At first she felt worse and wanted to quit, but her husband held her to her promise to stick with it for three months. Six weeks later, on August 25, 2000, Oler took her last psychiatric drug. After 37 years of misery, claims Oler, she was well.

What Oler used, and attributes her current state of mental well-being to, is EMPowerplus, a vitamin and mineral supplement developed by a Raymond, Alberta, company called Truehope. The company claims that tens of thousands of people with mental illnesses around the world have tried their product (42,000, to be specific). They claim that the majority of those people—over 80 per cent—have experienced a significant reduction of psychiatric symptoms. 

It’s quite a claim. The medical community has invested billions of dollars researching mental health. Pharmaceutical companies have posted profits in the billions of dollars from the sale of products aimed at alleviating the symptoms of mental illness. The brand names of some the most common treatments—Paxil, Valium, Zoloft—have infiltrated our language and popular culture. There’s a lot at stake for the pharmaceutical industry, not to mention for sufferers of mental illness and their families. And yet a rural Alberta-based company staffed by people without medical credentials now claims that their product—a mix of vitamins and minerals—addresses some forms of mental illness more effectively and safely than conventional medicine.

EMPowerplus has attracted as much skepticism, scrutiny and criticism as any legal health product in Canada over the past decade. The product is being sold to treat serious maladies such as bipolar disorder, anxiety disorder, panic attacks, attention deficit disorder, schizophrenia, autism, Tourette’s syndrome, fibromyalgia and obsessive-compulsive disorder. Health Canada and many in the medical community are concerned that people suffering with disorders of the central nervous system such as these are particularly vulnerable to health products available without prescription. Critics are not convinced that symptoms of such illnesses can be sufficiently alleviated with something as simple as a nutritional formula. They’re uncomfortable with Truehope’s non-medical staff advising clients to begin the process of getting off their psychiatric medications as they begin their EMPowerplus “program.”

Not everyone responds as positively as Oler did. For Sheri Braun, a Sherwood Park high school English teacher, switching from her psychiatric medications to EMPowerplus was, in the end, impossible. “I wanted it and really thought I could do it, but I couldn’t,” she says. Braun took Effexor, Zoloft and Xanax for many years, and wasn’t satisfied with how they were working. She was particularly uncomfortable with her high dose of Xanax, and the length of time she’d used it. Xanax is a benzodiazepine, meant for short-term usage. “I knew I had to do something about the benzo, and that I faced the gruelling hell of going off one mind-bending drug to go on another, so I was going to try a new route, one that seemed to hold a lot of potential,” she says. “I’d done what the doctors told me to do for years, taken all my medicines, and I wanted to try the Truehope program.”

In March of 2007 she started taking EMPowerplus and decreasing her doses of other medications. She reads me pieces of her own writing during that period. “I’ve caught a glimpse of health, of tingling that isn’t anxiety, of real laughter, real tears,” she reads. “Music has returned. It’s not just dead noise anymore. I’d been stolen from myself. I was colour blind and now I see.” Her energy was good and she felt she was healing.

And then, disappointment. “I’d wake in the night sobbing… I felt like a person with no skin. I’d have these brain jolts, jumps, stalls. I’d have to set the timer to remind myself to keep emptying the dishwasher.”

“It was like falling into a black hole,” she says, apologizing for the tremor in her voice. She’d wake up to terror which persisted all day, every day, for two months. She lost too much weight and wasn’t functioning. She was on suicide watch. She ended up in the hospital. 

“I’m on Celexa now, and just a low-dose benzo, nothing like before,” she says. “I felt like I’d failed, but I didn’t. I didn’t kill myself. I’m still here for my kids.” Braun is getting her life back, and has gone back to a part-time teaching position. 

“[EMPowerplus] just didn’t work for me. Everyone’s different,” she says. “But Truehope needs a detox centre and doctors who can monitor up close and order lab tests. Long-distance just isn’t enough for some of us.”

Some studies show a “significant” improvement in psychiatric symptoms in over 80 per cent of users. Dr. Charles Popper: “The economic implications… for the pharmaceutical industry are difficult to overlook.”

The Truehope story starts in 1994 when Anthony Stephan, an engineer living in Cardston, lost his wife, Debbie, to suicide. Two of his children, Joseph and Autumn, had severe treatment-resistant bipolar disorder, and Stephan worried about their future. In 1996, Stephan learned from animal nutritionist David Hardy that pigs prone to harming each other were responding well to a micronutrient supplement. He and Hardy adapted a similar formula for humans and tried it on the Stephan children. They responded “beautifully,” so Stephan stopped administering his children’s psychiatric medications. The children stayed healthy. Stephan and Hardy formed Truehope and began making the product available to other bipolar sufferers. They collaborated with Alberta Children’s Hospital psychologist Dr. Bonnie Kaplan at the University of Calgary. The Alberta Science & Research Authority commissioned a study, kicking in $544,000 in funding.

The results of preliminary trials were published in the Tennessee-based Journal of Clinical Psychiatry in December 2001. Other peer-reviewed articles and small-scale trials followed. All of them reported a “significant” improvement in psychiatric symptoms in more than 80 per cent of participants, with the need for psychotropic medications reduced by more than 50 per cent. They claimed that some patients stabilized to the point of no longer needing any conventional psychiatric medications. (A larger, double-blind, placebo-controlled study is currently under way at the U of C.)

Just like the makers of pharmaceutical medicine, proponents of “alternative” medicine face legal and medical hurdles. 14 years after Stephan first tried his supplement on his children and seven years after the first study was published, Health Canada is not ready to give EMPowerplus the green light. 

Health Canada is mandated to scrutinize new health products and ensure their safety for Canadians. Their major concerns about EMPowerplus include the fact that Truehope makes therapeutic claims for a product not yet widely tested, that some of the ingredients may be harmful and that non-medical staff at Truehope recommend patients decrease or eliminate their psychiatric medications as they begin the EMPowerplus program. 

Health Canada’s definition of a natural health product is multi-layered; the agency determines which natural substances (originating in plants or animals) claiming therapeutic value are permissible as natural health products and which must be classified as drugs. It also determines safe dosages. Since Truehope claims EMPowerplus is useful for treating such illnesses as depression and bipolar disorder, and since a number of nutrients in the product exceed Health Canada’s daily recommended amounts, Health Canada’s position is that the product must be tested as a drug. 

In 2002, Health Canada charged Truehope with selling an unauthorized health product and advised them to apply for a Drug Identification Number (DIN). They halted the trials being conducted at the University of Calgary, sent out media advisories on the risks of EMPowerplus, ordered an RCMP raid on Truehope offices, seized patient records and began stopping shipments at the border. Some 3,000 Canadians using EMPowerplus were informed that they should go back on their psychiatric medications. 

Stephan and Hardy responded by arguing they were compelled to protect the health and safety of those who had come to depend on EMPowerplus. In January 2004, the Natural Health Products Directorate (NHPD) became law in Canada; in March, minister Pierre Pettigrew granted Truehope an exemption, permitting EMPowerplus to be imported for personal use (it is manufactured in the US). With their DIN pending, and believing that EMPowerplus actually fell under the scope of the NHPD, Truehope applied for a natural product number (NPN). “[The number] was granted verbally, but then, after huge delays, we were told we’d only be granted one if we excluded boron, which is an ingredient in the product but available anywhere,” says Truehope’s director of regulatory affairs Ian Stewart. “We’ve kept meeting their changing list of requirements, one ingredient at a time, but they still haven’t issued approval.”  

The case went to a hearing. On July 28, 2006, Alberta Provincial Court Judge G. M. Meagher ruled in favour of Truehope. Though EMPowerplus has yet to be issued a DIN or NPN, Truehope continues to sell their product under the ministerial exemption.

Fast forward to the spring of 2008 and the emergence of Bill C-51, a proposed amendment to the Food & Drugs Act. The Bill was not passed before the October 14 federal election, but opponents believe a similar bill will be reintroduced in the new parliament. C-51 would have required life-cycle monitoring of pharmaceuticals, mandatory reporting of adverse events, and a separate category for natural health products (NHPs) with an approval process that takes into account traditional knowledge, history of use and such products’ low risk profiles. 

The new categorization of NHPs—under the umbrella of therapeutic products—has Truehope worried. The company actively opposed C-51, and was one of the parties chiefly responsible for the “Stop C-51” website. The tenor of the site, particularly its accusations of corruption at Health Canada, raised questions about the credibility of its arguments—and prompted people to ask why Truehope would behave antagonistically toward the agency, given its mandate of protecting public health. 

Truehope defends the website. “[C-51 would’ve] given our health minister power to decide which products should be categorized as natural health products and which [ones] should be categorized as prescription-only medicines,” says Stewart. “Anything that has serious benefit for serious illness… could be moved to prescription status.”

The problem, from the perspective of the makers and potential users of EMPowerplus, is that psychiatrists are trained in pharmaceutical medicine and, having little knowledge of biological and nutritional medicines, are, with few exceptions, reluctant to work with natural products. 

Alberta psychiatrist Dr. John Boodhoo is one of those exceptions. “I’m an allopathic doctor: I prescribe treatments I’ve been trained to prescribe,” he says. “But I do support alternatives and choices. I have patients who use pharmaceuticals and EMPowerplus because sometimes one isn’t enough, and, as we know, [psychiatric] medications don’t work for everyone. So when clients want to use it, I see my role as one of support. I work with them.”

Is EMPowerplus safe Truehope claims the risk of harm is “remote.” Health Canada will not discuss details about risk assessment and licence application status, for reasons of confidentiality. Health Canada has, however, begun to track adverse reactions to EMPowerplus, and has nine physician-reported reactions thus far. “We’ve looked into the reactions we’ve had access to, and each case involved other medications known to cause the adverse effects that were recorded,” argues Stewart. “We’ve asked for the rest of the files, but so far haven’t been given access.” Truehope has thousands of people in their participant database and claims to have received no reports of serious reactions that don’t match complications of the drugs participants are phasing out. Adverse reactions reported in Bonnie Kaplan’s preliminary clinical trials at the U of C were limited to “infrequent, minor and transitory” nausea. 

The bigger concerns seem to lie elsewhere. Marc Banik, a professor of bioindustry at l’Université du Québec à Montréal (UQAM), is currently examining EMPowerplus. There is “some scientific evidence supporting the claim that many of the conditions targeted by EMPowerplus may be treatable by vitamin and mineral supplements,” he says. “To my knowledge, Health Canada has not contested this, and its own health hazard evaluation doesn’t raise significant concerns as to the toxicity of the product. The main point of contention is whether the use of the product is safe in light of the fact that potential users end up abandoning their conventional therapy prescribed by their licensed physician or psychiatrist. It’s known that ceasing conventional antidepressants can cause serious side effects or cause symptoms of mental illness to return.” 

Of course, symptoms can return on psychiatric medications too—psychiatric medications often lose their effect over time, and some are known to be unsafe if taken for more than a short time. While many sufferers owe their lives to them, others are what is known as “treatment resistant” and experience little or no symptom improvement. And most people using EMPowerplus are those for whom conventional medications haven’t worked. “Many of our clients have been so successful that they’re symptom-free and need no more than a seasonal check-up visit,” claims Stewart. 

Most of the staff at Truehope—from the founders on down—have no conventional medical training. UQAM’s Banik says that people without medical training giving medical advice “shouldn’t be permissible… and in fact isn’t, according to NHP regulations.”

Harvard psychopharmacologist Dr. Charles Popper testified in court that Truehope’s founders taught him how to help patients manage the transition from pharmaceuticals to EMPowerplus, calling Stephan and Hardy “experts” on the product for use with mental health conditions. He also testified that clinicians and researchers may need to rethink the traditional bias against nutritional supplementation as a potential treatment for major psychiatric disorders, and that EMPowerplus can restore normal behaviour to seriously ill patients—a testimony that, given Popper’s initial resistance and preference for the drug protocols he knows well, carries some weight. 

Popper also noted that “the economic implications… for the pharmaceutical industry are difficult to overlook.” Indeed, Truehope and its proponents believe that the pharmaceutical lobby was the main force behind Bill C-51. Duff Conacher of the Ottawa-based citizen advocacy group Democracy Watch provides specifics about the industry’s influence: “Canadian figures on what the lobby spends are estimations at best, as neither our provincial nor the federal government require disclosure on how much comes in from Big Pharma,” he says. But US figures may give an indication of the magnitude of influence—the pharmaceutical industry spent $168-million on lobbying Washington last year, and was, in 2006, the largest lobby group in the US.

Health Canada’s concerns include the fact that Truehope makes therapeutic claims for a product not yet widely tested, and that their non-medical staff recommend patients decrease or eliminate their psychiatric meds.

Health Canada’s concerns are shared by many in the medical community and by “skeptic groups” such as Quackwatch, a US non-profit that combats health-related frauds and which lists EMPowerplus as a “questionable treatment.” Quackwatch itself has critics; natural health advocate Helke Ferrie has written that its funding sources were readily available on the Internet until recently, and that donors listed in past annual reports included “all the big petroleum and pharmaceutical companies.” 

The co-authors of Pig Pills Inc., Dr. Terry Polevoy, Marvin Ross and Ron Reinhold, argue that EMPowerplus is unproven. “The biggest scandal of all,” they write on their website, “is the number of innocent people who have been or could have been harmed because they followed the advice of untrained lay people who advised them to either take their special ‘pig pills,’ or… stop their psychiatric medications altogether. The issue here is not the fact that people just wasted their money; some have had their hopes for good health shattered once again.” Critics of the book note that Ross has acknowledged that a pharmaceutical company helped cover his travel costs for an event at which he spoke against EMPowerplus. They also cite writing he has done on behalf of various pharmaceutical companies.

Roughly 23,000 Canadian deaths each year are related to prescription drug use, claims Helke Ferrie. Conservative MP for Yellowhead and former chair of the House of Commons health committee Rob Merrifield says that the figure is “maybe 10, 20, 30,000 deaths a year.” What is clear, however, is that North Americans are the most medicated people in the world. And while prescription drug sales in the US tripled between 1980 and 2000, life expectancy dropped from 11th place to 42nd. There are, of course, many factors at work, but some medical professionals are starting to express concern that a reliance on pharmaceuticals is as much a cause of declining health as a reflection of it.

Alberta Health & Wellness reform initiatives include expanding and improving mental health services to include a greater focus on preventive health. This could include alternative treatments. Some doctors trained in traditional psychiatric medicine have already waded in beyond the shoreline of convention. “I just love getting up to go to work,” says psychiatrist Estelle Goldstein. “It’s very satisfying to see [mental illness] symptoms recede, and to see them recede without side effects is even better. But the life changes that go over and above the change expected to come with the alleviation of symptoms… it’s just very, very exciting.” She’s talking about the people she sees in her psychiatry practice, people she now treats primarily with an array of natural health products—of which she says EMPowerplus is now the cornerstone. 

Goldstein, who has served residencies in general surgery, neurosurgery and psychiatry, and fellowships in neurology and psychopharmacology, was a big fan of psychopharmacology… at least until she found herself in “some serious metabolic misery.” She learned about natural approaches to health, and found, much to her surprise, that the topic of nutritional therapies was backed by sound science and discussed even in mainstream medical journals. Wanting to apply her newly discovered knowledge to psychiatry, she stumbled upon Truehope through the research conducted by Dr. Kaplan at the U of C.

“I opened Pandora’s box,” laughs Goldstein. “I called Bonnie [Kaplan] and asked if this stuff really works, and she told me ‘You bet it does!’ Which it does, though I have to insert a disclaimer here. Not everyone responds equally, and I don’t use only EMPowerplus. I use it in conjunction with essential fatty acids and specific amino acids, and, when patients still don’t respond fully, a holistic approach that addresses related underlying health and metabolic disorders. But still, I see so much I never dreamed I’d see. I’ve been in practice for 17 years and I’m amazed with the results I see. These nutrients get past the blood/brain barrier and they work.”

Over the phone from her home in Lethbridge, Jerry Oler tells me it’s been eight years since she left psychiatric medications behind in favour of a nutritional supplement.

“I was taking over 70 pills a day, couldn’t work, depended on social workers, welfare, home care support, you name it,” she says. “Now I can work, pay taxes, enjoy my grandkids. I haven’t been back to the psych ward. I haven’t needed to be on suicide watch. I used to have rages, I used to beg for death. I needed someone to stay with me when my husband went to work. Now I’m fine. And I wouldn’t go back on psychiatric meds, not for anything, not ever.” 

Connie Howard lives in Edmonton. She looks at health topics—especially under-reported issues, practices and treatments—in her regular column in Vue Weekly. 

The post Going Natural appeared first on Alberta Views.

I had been smoking and coughing for more than 20 years, yet that incident shocked me into an attempt to beat the weed. I went cold turkey. With as much gravitas as I could muster, I informed family, friends and associates that I’d be bloody miserable for the next few months. And I lived up to my warning. I was grouchy, irritable, often angry and frequently depressed. But I didn’t smoke. I thought I had won the battle when, six months later at a party, I looked down and saw a half-smoked menthol cigarette in my hand. I couldn’t remember how it got there. This addiction was serious and sneaky. I butted out and haven’t smoked since.

It’s surely more good luck than good management that smoking is the only addiction I’ve ever had. But I have long  been fascinated by the power of chemical comforts. I worked   as the head of education for provincial alcoholism programs     in Alberta and Saskatchewan in the 1960s. And after watching two respected broadcasting colleagues drink themselves to death, I developed and taught a University of Alberta extension course called “Man and Chemical Comforts” and later produced a handbook titled Drugs: Our Bittersweet Companions.

“Bittersweet” was an apt word for me at least partially because of a group of researchers in Saskatchewan. They claimed that therapeutic use of an accidentally discovered drug—dlysergic acid diethylamide, otherwise known as LSD or “acid”—was the most effective way to treat alcoholics.

Psychologist Duncan Blewett, one of the principal researchers, described the drug’s emergence as “one of the three major scientific breakthroughs (alongside the splitting of the atom and  the ability to manipulate genetic structure) of the 20th century.” Like their contrasting approaches to politics, Alberta  and Saskatchewan dealt with alcoholics in cosmically different  ways in the early 1960s. In both provinces, attitudes toward drinking were predominantly moralistic, with remnants of the Women’s Christian Temperance Union still preaching against  the “demon rum.” Alcoholism was perceived as the major addiction of the era; treatment regimes relied on the principles of Alcoholics Anonymous, which included a spiritual component and acknowledgement of an undefined “higher power.”

In Alberta, the Department of Health oversaw established clinics staffed by psychiatrists, psychologists and professional social workers—pretty standard stuff. In Saskatchewan, how- ever, home of medicare and North America’s first socialist government, the Bureau on Alcoholism was mostly run by recovering alcoholics who were still active members of AA. And for a few years in the early 1960s, when patients were sent (or dragged) to the bureau, the ultimate treatment was LSD    therapy.

LSD was discovered in 1943 by Swiss researcher Albert Hofmann. While trying to find a cure for migraine head-  aches, he accidentally ingested a small amount of what a 2002 National Film Board documentary describes as “Hofmann’s potion.” For the next few hours, Hofmann found himself swept away by a torrent of wonderfully bizarre, otherworldly perceptions that, even half a lifetime later as an old man, he recalled as the most profound of his life.

In the late 1950s, psychiatrist Humphrey Osmond, in correspondence with novelist Aldous Huxley, coined the term “psychedelic,” meaning, from the Greek, “mind manifesting.” (The men became friends after Huxley offered to serve as an LSD test subject and they exchanged rhymes to come up with    a name for this new class of drugs. “To make this trivial world sublime, take half a gram of phanerothyme,” Huxley wrote, to which Osmond responded, “To fathom hell or soar angelic, just take a pinch of psychedelic.”) Osmond, alongside Duncan Blewett, chair of the psychology department at what was then the University of Saskatchewan, Regina Campus, began using LSD to treat alcoholics. By the time I joined the Bureau on Alcoholism in 1963, the LSD program was well underway, with some stunning results. Alcoholics, many seen as hopeless, were being rehabilitated into productive members of society.

One friend and former colleague—let’s call him “Andy”— was on the verge of being killed by the bottle. His wife and children had abandoned him; his father and most of his friends had nearly given up on him. Two of Andy’s remaining friends literally kidnapped him from a Prince Albert bar, wrestled him into a car and drove him to the provincial psychiatric   hos-

“In the LSD experience the vast extension of subjective time telescopes objective time so that all the emotional possibilities that would ordinarily be played out over years of the individual’s life are crowded into brief hours.”—Duncan Blewett

pital in Weyburn, then under the direction of Osmond. Andy was given a large dose of LSD and spent several days painfully working through the process that ultimately saved his life. His impulse to drink disappeared. He remarried, started a new family, re-established relations with his old family and is now a happily retired senior citizen living in Calgary.

“It was a spiritual experience that never left me,” Andy told me recently, talking about his LSD encounter. “I absolutely changed. In 44 years I have never,  never  again, ever,  wanted   a drink.” Andy became friends with Blewett, sometimes dragging other “recruits” in for treatment. Blewett became the most innovative therapist in the field, staying with patients around   the clock as they worked through the tortured, convoluted   roots of their addiction.

In the “Nightmare” sequence of a 1954 Gordon Jenkins album called Seven Dreams, a singer wails “I stole some bricks when I was six and I’m afraid to die.” Jenkins nailed the irrational fears that drive both nightmares and life-threatening addictions. Blewett once described LSD to me as “a microscope you put inside your skin.” It can magnify the inner workings of your mind with startling, sometimes terrifying clarity. His thesis was that addictions were often the product of massive self loathing and insecurity, that many people drank to dull their demons.

“In the LSD experience the vast extension of subjective time telescopes objective time so that all the emotional possibilities that would ordinarily be played out over years of the individual’s life are crowded into brief hours,” Blewett wrote in his book The Frontiers of Being, outlining his therapeutic process. “The intensity of emotion is magnified as it is concentrated in time. The individual finds himself in a dilemma that has   been described as comparable to finding oneself in complete darkness, clinging to a vine over what appears to be a terrible chasm. Every manoeuvre fails to find any support until, at last, one is forced by fatigue to ‘let go.’ When one does let go, it is to find that one has been suspended only a foot off the ground in the sunlight and wearing a  blindfold.”

We all have hidden demons, Blewett explained to me— things that we are ashamed or frightened of, things we desperately don’t want the outside world to see. So we build walls of psychic repression, fantasy and denial to conceal and contain them. The trouble is, we’re trapped on the same side of the walls as our demons, which tend to get bigger and stronger, forcing us to build the walls higher and higher. Drinking can temporarily keep these demons at bay. But to contain them, we need more and more alcohol. And then, of course, drinking becomes the problem.

LSD has the capacity to blow holes (or open windows) in the walls between our conscious and unconscious minds. It’s no surprise, then, that when LSD and other psychedelics became street drugs, they often led to bizarre tragedies, including suicides. The experience can be terrifying, even life threatening, if not managed properly. Blewett often took LSD with his patients, and when puffed-up demons like “I stole some bricks when I was six” rose to the surface, he helped patients put their fears into perspective. The goal was self acceptance, and, ultimately, self forgiveness. Nobody wants those old junkyard bricks anyway.

The Saskatchewan approach was beginning to attract interest and credibility in the scientific world when LSD hit the streets alongside other hallucinogenic drugs in the early 1960s. American authorities, reacting as they had in the 1930s when marijuana was criminalized, declared LSD an illegal substance. Prohibition pushed LSD underground, increasing its allure, especially among young people. Canada promptly cancelled the drug’s experimental status, bringing the work which had shown such potential in Saskatchewan to an abrupt halt.

Blewett, now in his mid 80s, lives on British Columbia’s Gabriola Island. Alzheimer’s disease is creeping up on him, according to his wife, June, but his memory for events in the distant past is strong. When I phoned him this past spring,  we reminisced about those “remarkably wonderful” times   in Saskatchewan. “A lot of people helped me,” Blewett said, sounding happy and serene.

After two years as the education supervisor of Saskatchewan’s Bureau on Alcoholism, I moved to a similar position in Alberta in 1965. The change was dramatic. The Alberta Department   of Health’s program operated well within the scientific and therapeutic mainstream. No LSD   here.

In Alberta, “the disease” was fought on two fronts. The first was based on AA: patients were encouraged to admit they’d lost control of their lives. The second front, which I oversaw until 1969, was education. Alcoholics, we repeated constantly, were not bad people; they were sick. We worked closely with doctors, nurses, psychologists and counsellors. Our message was simple: early intervention was the key.

According to AA, alcoholics generally must “bottom out” before treatment will work. Early intervention meant “raising the bottom,” setting clear limits and not tolerating unacceptable behaviour, such as booze on the breath at work or “I only had a couple of drinks” excuses to spouses. This creates a crisis for alcoholics, bringing closer the day when they realize they’re out of control. We taught health workers to recognize early symptoms (drinking alone or at inappropriate times, acting aggressively, alienation from family and friends) and to  see through the manipulations (stashing bottles, switching to odourless vodka) addicts created to cover up their  condition.

I worked with the conviction that this was the best way to counter alcoholism. Meet it head on by making sure that its signs and symptoms were as widely understood as possible. Moreover, true education, I argued, meant “teaching the teachers”  in the public school system. We had to infuse all aspects of the curriculum with information on addictions; not only obvious areas like health and social studies, but also chemistry, biology, geography, sociology, history and even literature and economics.

But many education and health professionals resisted. They felt that addictions could only be dealt with successfully by specialists. Schools preferred to have outside “experts” come into the classroom to give graphic and sometimes fearful lectures about the “evils” of alcohol and drugs. Health workers preferred dedicated treatment centres. Hospitals generally resisted admit- ting alcoholics in crisis—people who had to “dry out” from “the shakes” of delirium tremens. They were messy, hard to control, and never seemed to learn their  lesson.

In an argument that resonates even more loudly today, most Alberta health care professionals at that time insisted they   were already overloaded with too many responsibilities and had too few resources. Alcoholism and addictions programs became more expert driven, more institutionalized. I argued against turning the challenge over to experts. In hindsight,   perhaps I was too idealistic, if not naive, but I tried to make the case  that the broader the intervention, both on the education and    the health fronts, the better the long-term chances of mitigating the devastating effects of addictions on society at large. If addictions were seen as everybody’s problem—families, physicians, educators, employers—early intervention would save both lives and dollars. Leaving it to the experts, I believed, would create increasingly cumbersome, bureaucratic institutions that, under their own weight, would be rendered increasingly  ineffective.

It was a battle I lost. In the late 1960s, the provincial

Like their contrasting approaches to politics, Alberta and Saskatchewan dealt with alcoholics in cosmically different ways in the early 1960s.

Division of Alcoholism began planning a specialized treatment centre for alcoholics. I argued that the facility would let main- stream health professionals and hospitals off the hook. But the Alberta government created Henwood, a highly specialized in- patient treatment facility, in a complex originally designed to serve as a minimum security prison.

When Canada followed the United States and made LSD illegal in the mid 1960s, the treatment of alcoholism, and addictions in general, went back to the tried and traditional methods created by Alcoholics Anonymous in the 1930s. The promising Saskatchewan experiments ended. Today, we struggle to cope with a growing list of dangerous addictions using the old approach. Addiction programs are bigger and more expensive, but success rates haven’t really changed over the decades. Roughly 75 to 90 per cent of all alcoholics or addicts relapse within a year of their release from traditional treatment programs.

The Alberta Alcohol and Drug Addiction Commission was created in 1970, absorbing the Division of Alcoholism. I had already left the program to resume a career in broadcasting. In 2004, more than a generation later, I set out to learn how today’s institutions are dealing with a complex range of addictions.

With an annual budget of $66-million and a staff of nearly 600, AADAC offers treatment and education programs for alcoholism and an array of drug dependencies, including tobacco, and for gambling addictions. It handles more than 30,000 treatment admissions, 70,000 shelter admissions and 120,000 prevention and education contacts every year. AADAC’s offices, clinics, institutions and community service agencies are located in more than 45 communities throughout the province. In addition to Henwood, there are 22 other in-patient facilities for detoxification and for intensive and long-term  treatment.

AADAC is a big organization, arguably the most advanced  and well funded of its kind in Canada. In the 1960s, Ontario’s Alcoholism and Addiction Research Foundation led the way, and there were strong agencies in B.C. and Quebec. But today, according to the CEO of AADAC, Murray Finnerty, on a per- capita basis Alberta’s program is the best funded in Canada, perhaps in North America. Still, AADAC officials are struggling to keep up with the demand for services. “It’s an increasingly complex world,” Finnerty said. “There’s more stress, a growing population, more seniors with time on their hands, more  family break-ups, more substances more readily available, more multi- drug addicts. All of our treatment centres have waiting lists.”

Up to 50 people turn up at AADAC facilities every day looking for help. Those in severe need of detoxification go to the head of the line and are usually admitted the same day. But people looking for individual counselling may have to wait up to 12 days. For patients seeking intensive day treatment,  the wait can be two to four weeks. To get into Henwood, the province’s flagship in-patient facility, one must wait five to six weeks. AADAC studies indicate that the rate of most addictions  is not changing—between 5 and 10 per cent of Albertans,  more or less, can be deemed addicts. But a growing population, particularly in booming centres like Calgary, Fort McMurray and Grande Prairie, is putting pressure on the system.

These days, there’s little talk about “saving” alcoholics, or addicts of any kind. That approach motivated us in the 1960s, but today’s focus is on “harm reduction” (which doesn’t mesh with the AA maxim about alcoholics always being one drink away from a drunk). “We’re just being realistic,” Finnerty said. “The  ultimate  goal  is  still  total  abstinence  from  the  harmful substance. But there can be many steps along the way.” One example of harm reduction is AADAC’s support of needle exchange programs for intravenous drug users. “We may, over time, be able to get some of those people off drugs,” Finnerty said. “But if they end up with HIV, nobody wins.”

Finnerty has a four-point strategy for tackling addictions in Alberta. First, we need to do a better job of managing demand. “We need to develop a comprehensive strategy for early intervention on alcohol issues like drinking and driving, binge drinking, and the kind of excessive behaviour that follows Stanley Cup hockey games, for example. We need to work with police, with health authorities, with social agencies, with educators. Second, we need a comprehensive drug strategy, emphasizing a community approach. Third, we need an up-to-date tobacco reduction strategy. And fourth, we need to be proactive and throw more light on gambling and its problems.” The key to all four points, Finnerty told me, is to make these problems everybody’s problems. This sounds familiar, and it’s the truth: no agency can succeed on its own.

Although dealing with alcohol and drugs alone would be a handful, in the mid 1990s AADAC’s mandate was expanded to include tobacco and gambling. Alcoholism remains the largest part of its work, accounting for nearly 60 per cent of its case- load, and the eruption of cheap and powerful designer drugs  like crystal meth presents a fresh challenge. But so does a 2001 decision to make AADAC’s offices and staff smoke free. If you want to work for the commission today, you have to be a non- smoker. Gambling, too, is a new foe for traditional addictions counsellors because it involves no physical drug. Considering the spread of gambling venues, including the weed-like proliferation of instant-pay, instant-gratification video lottery terminals, coping with this addiction has become a growth industry. Gambling is now stigmatized the way alcoholism was in the 1950s. Addicts rationalize and hide their problem and avoid seeking help until they lose everything—savings, jobs, family.

But there’s no point asking AADAC officials about the  growth of gambling in Alberta. Their budget, like those of many arts and culture groups, as well as many community and charitable organizations, depends on the roughly $1.5-billion the province rakes in from gaming and horse racing every  year. As we start to question our society’s increasing reliance on gambling, some groups are backing away on moral grounds. In a dramatic announcement last April, the Alberta Knights    of Columbus, a Roman Catholic fraternal organization, said it would no longer participate in fundraising casinos, giving up an estimated $1-million a year. The KCs are not alone. The Edmonton Food Bank, for instance, has opted out of lottery funding.

These decisions may indeed influence government policy, but I suspect gambling won’t be the last addiction our province asks AADAC to tackle. What about eating disorders Sex and the booming porn industry Unbridled greed Whatever the future conjures, we already know that today’s resources can’t meet the demands of a growing population that has a proliferating constellation of addictions. This imbalance between demand for services and our means to deliver them is one of the great challenges of the early 21st century. And until we realize that addictions are everybody’s problem, we’re really just adding more bricks to the walls that trap us with our demons.

Fil Fraser is an Edmonton-based writer, broadcaster and film and television producer. 

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